Middle ear tuberculosis

Abstract

Fourteen cases of tuberculous otitis media are reported. With the declining incidence of pulmonary tuberculosis, the number of reported cases of tuberculous otitis media has become scanty. Nowadays the so-called classical signs of the lesion such as a profuse discharge, profound hearing loss, facial paralysis and multiple perforations, are hardly ever seen. Surgical intervention when done under cover of anti-tubercular drugs has no deleterious effect on the result of surgery. In order not to miss tuberculous otitis media, whenever the otologist is dealing with chronic middle ear disease, the following points should always be kept in mind: (a) A dull ache in the ear without obvious inflammatory signs. (b) A whitish-grey appearance of the mucosa. (c) Bulging of granulation tissue from the mastoid cells during surgery.

Tubercular otitis media: an under diagnosed entity

“…3 Superadded infection makes it difficult to demonstrate tubercular bacilli in ear discharge, and culture also provides a low yield. 26 Culture for Mycobacterium tuberculosis (performed using BACTEC system) was positive in 25% (3) cases in this study, while others have found culture positivity to the extent of 16.13% (Yaniv E, 1987), 28.57% (Plester et al, 1980) and 90.91% (Windle Taylor PC and Bailey CM, 1980). 6,7,23 Mantoux test was positive in 83.33% (10) cases, while it was 100% in the study of Yaniv.…”

“…27,28 Chest X-ray showed evidence of active pulmonary tuberculosis in 66.67% (8 cases). Results from other reports include a positivity to the extent of 42.86% (Plester et al, 1980), 51.61% (Yaniv E, 1987) and 93.02% (Singh B, 1991). 7,8,23 The imaging modality of choice in cases of TOM is CT-scan.…”

“…Primary involvement is exceedingly rare. Although secondary involvement of temporal bone is the commoner type, a high incidence of primary type was reported by Plester et al 7 The various routes by which the tubercular bacilli gains access into the middle ear cleft are -aspiration of infected mucus through Eustachian tube, haematogenous spread, contiguous involvement from adjacent intracranial or extracranial infected focus, and rarely as a direct seedling through external auditory canal via perforated tympanic membrane. 2,3 Other rare routes mentioned are transplacental transmission and via infected birth canal.…”

“…However, in certain cases there is neither a tympanic membrane perforation nor the associated otorrhoea. 7 Multiple perforations of tympanic membrane, though once considered a hallmark of TOM, is not a valid diagnostic criteria now. It is believed that these multiple perforation coalesce to result in a single large perforation.…”

Impending Meningitis in a Case of Tuberculous Otitis Media

“…A characteristic clinical finding is granulomatous middle ear mucosa which is pale and a vascular. Multiple perforations of the tympanic membrane cannot be substantiated as a hallmark of tuberculous otitis media [10]. As the pathologic process advances inexorably, the granulations lead to attico-antral blockage and destruction of nearby tissues such as skull base or the tegmen tympani, leading to tuberculous meningitis or skull base osteomyelitis [10,11].…”