Tuberculous Otitis Media: Report of 2 Cases on Long Island, N.Y., and a Review of all Cases Reported in the United States from 1990 through 2003

Abstract

We report 2 cases of tuberculous otitis media that were diagnosed at Stony Brook University Hospital in New York since 1999. Both patients were women, aged 30 and 31 years. One p atient had grown up in Russia, the other was a native-born American who had never left the East Coast region ofthe United States. Both p atients had been symp tomaticfor many months; one comp lained ofchronic otorrhea, and the other reported otorrhea, hearing loss, and discomf ort. Ne ither patient responded to medical management, and both ultimately underwent surgery. One was diagnosed after surgicalp athology revealedacid-fast bacilli on frozen-section analysis. In the other, pathology revealed chronic inflammation andgranulomata, but stains were negat ive and her diagnosis was delay edfor almost 2 years. We also review 9 other cases of tuberculous otitis media in the United States that have been reported in the literature since 1990. Our review suggests that the number ofcases is rising in areas where tuberculosis is most common-that is, in major U.S. cities.Although 3 ofthese 9cases occurred as reactivation disease in immigrants, most might have occurred as a result of local transmission. Clinicians should maintain a high degree ofsuspicionfor tuberculosis in patients with chronic otitis symp toms, particularly those who are at higher risk of exposure to tuberculosis.

Diagnosis of Concurrent Pulmonary Tuberculosis and Tuberculous Otitis Media Confirmed by Xpert MTB/RIF in the United States

“…Establishing a diagnosis of TOM can be challenging, particularly since TOM may mimic other rare causes of chronic otitis media, including nocardiosis and non-tuberculous mycobacterial infection,[8,9] and because the sensitivity of Kinyoun staining and culture performed on otorrhea or intraoperative specimens is typically low. [2,8,10]…”

Tuberculous Otitis Media with Facial Paralysis Combined with Labyrinthitis

“…TOM was first reported in 1853, and the organism was first identified in ear discharge in 1883 3,4). TOM is a very infrequent cause of COM, and is rarely considered in differential diagnosis 1,5).…”

The Variable Clinical Presentation of Tuberculosis Otitis Media and the Importance of Early Detection

“…Indicators of TBOM, such as past and personal history favoring TB infection and positive chest x-ray and Mantoux test results, should not be disregarded. A positive Mantoux test is common and frequently regarded as a sign of past TB exposure in high-burden areas, such as the Philippines (5), but a positive test among individuals who had a previous negative result and are living in low-burden areas may indicate the presence of active infection (6). A closer study of the CT images of the temporal bone and tissue specimen biopsy must be routinely requested to exclude TBOM (16,17).…”

“…Despite its rarity, considerable interest remains regarding its diagnosis and treatment because tuberculous otitis media (TBOM) cases are easily mistaken for the more common nontuberculous middle ear infection, sporadic cases continuously seen even in well-developed countries among migrant populations and immunocompromised host (2), fear of undiagnosed cases in apparently normal-looking individuals, treatment failures associated with profound hearing loss and other serious complications (3), the advent of new diagnostic tests that enhance disease detection (4), and the emergence of multidrug-resistant-TB bacilli (5). Previous reports emphasized 2 clinically important issues, namely, detection of TBOM depends both on microbiologic diagnosis and having a high index of suspicion on the presence of the disease (6), and early detection is important for better treatment outcome (7). However, the predictors to obtain a high index of suspicion are not well emphasized, and evidences to show the value of early disease detection are lacking.…”