Tuberculosis in the head and neck: experience in India

Abstract

Objective: With improvement in economic and social conditions and the use of effective anti-tubercular therapy, the developed nations, and most developing nations, have enjoyed a decline in tuberculosis for several decades. It is now seen that extra-pulmonary presentations form a major proportion of new cases, especially since the advent of the acquired immunodeficiency syndrome epidemic. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region and its varied manifestations. We report the increased incidence of isolated head and neck tuberculosis, its various presentations and clinical manifestations over a 10-year period.Materials and methods: A 10-year (1995 -2004), retrospective study was undertaken by the department of otolaryngology and head and neck surgery, Kasturba Medical College, and its allied hospitals, Mangalore, South India, involving a group of 165 patients with head and neck tuberculosis. Each patient underwent a detailed clinical examination and a battery of investigations. Most patients were treated with anti-tubercular therapy alone; others required surgical intervention followed by Antitubercular therapy (ATT). In addition, those with human immunodeficiency virus infection or malignancy were treated with anti-retroviral therapy and radiotherapy, respectively.Results: Of the 165 cases, 121 (73.3 per cent) had isolated tubercular lymphadenitis, 24 (14.5 per cent) had laryngeal tuberculosis, four (2.4 per cent) had tubercular otitis media, three (1.8 per cent) had tuberculosis of the cervical spine, three (1.8 per cent) had tuberculosis of the parotid, eight (5 per cent) had tuberculosis of the oral cavity, one had tuberculosis of the temporo-mandibular joint and one had tuberculosis of the nose. Fine needle aspiration cytology was highly effective in the diagnosis of tubercular lymphadenitis (92 per cent) but not so for other sites. The purified protein derivative (PPD) test was positive in only 20 per cent of cases. Pus for culture and sensitivity was positive only in caries of the spine and mandibular tuberculosis. Excision biopsy and histopathological examination were required to make a diagnosis in tuberculosis of the oral and nasal cavities, salivary glands, ear, temporo-mandibular joint, and mandible. There were 40 cases (24.2 per cent) with coexisting pulmonary tuberculosis and five cases (3 per cent) with coexisting malignancy. Of the 65 patients who were tested, 30 per cent were found to have coexisting human immunodeficiency virus infection.Conclusion: In addition to cervical lymphadenitis, tuberculosis in the head and neck region can produce isolated disease in the oral cavity, ear, salivary glands, temporo-mandibular joint, nose and larynx. Seventy-five per cent of our head and neck tuberculosis patients did not have pulmonary involvement. Fine needle aspiration cytology was highly effective in the diagnosis of nodal tuberculosis, but histopathological examination was required to make the diagnosis in other head and neck sites. ...

An unusual focus of extra pulmonary tuberculosis

“…One patient had temporomandibular joint involvement, and one had TB of the nose. 7 In the present case the patient suffered from TB at the age of 19 years and underwent treatment for the same. The current medical status confirms the patient to be suffering from TB.…”

Parotid abscess: mini-pictorial essay

“…Tuberculosis of the parotid gland is a rare clinical entity even in countries where the disease is endemic [6,7]. Clinically, it generally presents as a localized, unilateral, slow-growing parotid mass with a certain degree of fixation indistinguishable from salivary gland tumors [8], in this cases the histopathological examination is characterized by tuberculoid granulomas, with caseous necrosis, Langhans giant cells and epithelioid cells.…”

Tuberculous lymphadenitis presenting as inflammatory cervicofacial swelling in a 12-year-old girl

“…Agarwal et al in the clinicopathological analysis of 180 cases with tubercular cervical adenitis emphasized that the usual presentation of cervicofacial lymphadenitis is with multiple lymph node involvement without the constitutional signs and symptoms of tuberculosis as in the case presented here [17]. Prasad et al performed a 10 year retrospective study on 165 Indian patients with head and neck tuberculosis and concluded that 75% of the patients did not have pulmonary involvement [18].…”