A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region

Abstract

Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.

Otomastoiditis por Mycobacterium tuberculosis: Un diagnóstico desafiante

“…Se observan múltiples bacterias ácido-alcohol resistentes. 95% presentó con adenopatías cervicales, y solo 6 pacientes presentaron una otitis media tuberculosa 7 . Por otra parte, Ricciardiello y cols evaluaron a 1.391 pacientes que fueron ingresados a un hospital en Nápoles, Italia, con un diagnóstico de tuberculosis extrapulmonar durante un período de 16 años.…”

“…Los signos y síntomas incluyen la otorrea, hipoacusia, tinnitus, perforaciones del tímpano, tejido de granulación, presencia de pólipos en el conducto auditivo externo, otalgia y paresia o parálisis del nervio facial 4 . La otorrea es el signo más frecuentemente reportado, siendo refractaria a los tratamientos antibióticos típicos, seguido de hipoacusia y otalgia 5,7,8 . Los pacientes pueden igualmente presentar con vértigo y desequilibrio 6,8 .…”

“…A la otomicroscopía, se observan comúnmente perforaciones del tímpano, que pueden ser única o múltiples; sin embargo, se puede igualmente observar una membrana timpánica íntegra. Se pueden encontrar pólipos y tejido de granulación en el conducto auditivo externo, otitis media con efusión o retracciones de la membrana timpánica 5,[7][8][9] . Los pacientes pueden desarrollar hipoacusia neurosensorial, conductiva o mixta.…”

Tuberculosis: An Unusual Cause of Otitis Media and Mastoiditis in Children

“…Tuberculosis is one of the most common infectious diseases of developing countries. It rarely affects the middle ear [2,3]. It is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment [4,5].…”

“…A high level of clinical suspicion is needed for early diagnosis and antitubercular therapy should be started as soon as possible to prevent the possible complication [2,3,11].…”