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Objective Tuberculous otitis media (TB OM) is a rare disease. We present here our experience of TB OM on its clinical presentation, investigation and treatment outcome. Methods A retrospective observational study was performed and clinical data of patients in whom TB OM was diagnosed at our center between 2008 and 2019 was analyzed. Results Five cases of TB OM were identified. Otorrhoea was the most consistent presenting chief complaint while one of the cases presented with right post-auricular swelling. All the cases were successfully treated with anti-tuberculous medication with outcome of dry middle ear but only one case achieved full recovery of hearing loss. Conclusion Due to the disparity of presentations in all our patients, we would like to emphasize the high index of suspicion of TB OM in acute or chronic cases of otitis media with unusual presentation or poor response to standard treatment.

Tuberculous otitis media is a rare entity which requires high index of suspicion in an endemic country like India. A 38-year-old female with no prior history of tuberculosis or any predisposing factor presented to us with fever and altered sensorium. She was subsequently diagnosed to have disseminated tuberculosis with multiple cerebral tuberculomas. She complained of ear discharge which on further evaluation was established as smear positive tuberculous otitis media. This rare coexistence is seldom reported in literature.

Tuberculosis is a global health problem. Extrapulmonary tuberculosis remains to be a challenge in the diagnosis and treatment. Tuberculous otitis media being not so commonly diagnosed due to its varied presentation, early diagnosis and treatment remains to be a challenge. The aim of this study is to present the varied and unusual presentations and the importance of histopathological confirmation and new diagnostic tools like CBNAAT (cartridge based nucleic acid amplification test) which aids in the confirmation and to start anti-tubercular treatment (ATT). Five cases of tuberculous otitis media within a period of two years were included in the study. Among the five cases three cases presented with discharging sinuses, one with mastoid abscess and one with tuberculous otitis media with pulmonary origin. All five cases were confirmed with proper histopathological examination and two cases with CBNAAT (cartridge based nucleic acid amplification test) confirmation. Anti-tubercular treatment (ATT) was started and the patients were disease free. Tuberculous otitis media remains to be a rare complication of chronic suppurative otitis media and it has to be kept in mind while treating chronic suppurative otitis media. Classical presentations of tuberculous otitis media are not seen nowadays and the disease extending to the mastoid is the changing trend as the initial presentation. A proper suspicion with confirmation of the disease remains to be the gold standard for diagnosis and for treatment with anti-tubercular therapy.

Tuberculosis is an uncommon cause of chronic suppurative otitis media. Delay in diagnosis can lead to delayed treatment, resulting in significant complications. We describe a case of tuberculous otitis media with osteomyelitis of the craniofacial bones in a 44-year-old woman with chronic painless suppurative otorrhea, not responding to antibiotics, hearing loss, and facial palsy. Chest X-ray was normal. Computed tomography of the temporal bone showed the destruction of the left zygomatic bone, clivus, and petrous part of the temporal bone. Polymerase chain reaction was positive for Mycobacterium tuberculosis (MTB), and histopathological findings showed caseous necrotizing tissues. Sputum culture was negative for MTB. The patient was successfully treated with surgery and anti-tuberculosis drugs. The polymerase chain reaction is a sensitive, rapid diagnostic tool used to diagnose TB. Surgical approaches and operative biopsy should be considered when the cause of the chronic purulent discharge is still unknown.

Tuberculous otitis media (TOM) has no specific clinical presentation. Early diagnosis is necessary in order to avoid serious complications. The aim of this paper is rediscovering this rare forgotten disease that can re-emerge in a globalized society.A case of a 37 year-old woman with persistent unilateral otitis media with ear discharge and deafness since two years is presented. Systemic and topic antibiotic therapy was not effective. She underwent surgery twice with no improvement. As clinical conditions worsened, she was hospitalized. Histological examination and culture for mycobacteria detection revealed Mycobacterium tuberculosis complex infection.The patient was treated with anti-tuberculosis medical therapy for 9 months with clinical improvement.TOM is a diagnostic challenge and is often treated late because not suspected. Chronic otitis media not responding to common antibiotics should be investigated for tuberculous infection. Keywords: Tuberculosis, Otitis media, Atypical tuberculosis

Objective: The aim of this report is to describe an aggressive case of tuberculous otitis media in a young child and emphasize that surgical intervention and histopathologic studies can be employed to immediately arrive at a definitive diagnosis. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Participants: One Results: This is a case of a four-year-old boy who had refractory otitis media and erosive CT scan findings, mimicking aggressive CSOM manifestations. Due to unusual intraoperative granulation tissue characteristics, it was initially considered a malignancy, necessitating surgical intervention and biopsy that resulted in a definitive diagnosis of primary middle ear tuberculosis. Conclusion: This case represents the more severe end of the spectrum of tuberculous otitis media and supports the recommendation that a high index of suspicion, early detection, and prompt initiation of treatment are imperative in its management, especially in children with refractory otitis media. Keywords: tuberculous otitis media; tuberculosis; middle ear; otitis media; suppurative otitis media

The lesion of middle ear as a variant of clinical manifestation of secondary tuberculosis, according to international scientific literature, is a rare condition. However, in terms of real clinical practice, the proportion of this pathology should not be underestimated due to the wide spread of tuberculosis infection among the population of developing countries, including the Russian Federation. One of the risk factors for the systemic spread of mycobacterial flora is a concomitant HIV infection, which often acts as an opportunistic pathological agent for tuberculosis. The treatment of such a state is always challenging because of the high aggressiveness of bacteria and the low immunological resistance of the patient. This article presents a clinical case of bilateral tuberculosis otitis media, which was a manifestation of tuberculosis infection that developed on the background of HIV infection.Поражение структур среднего уха как вариант клинического проявления вторичного туберкулеза, по данным литературы, является редким состоянием. Однако в клинической практике удельный вес данной патологии нельзя недооценивать ввиду широкого распространения туберкулезной инфекции. Один из факторов риска распространения

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

Four cases of tuberculous otitis media in children are reported. One case presented with a postaural fistula, another case with signs of meningeal irritation and ear discharge and two cases as chronic otitis media refractory to conventional treatment. All patients underwent modified radical mastoidectomy and the diagnosis was made postoperativelyby histopathology in three cases and Ziehl-Neelson stainig of the discharge from the mastoid cavity in one. Clinical presentation and management of the cases are discussed. Tuberculosis should be considered in the diagnosis of children with chronic otitis media not responding to conventional antibiotic treatment.Targeted chemotherapy along with surgery provides rapid and complete healing.

Tuberculous otitis media is a relatively uncommon, approximately accounts for 0.05%–0.9% of chronic middle ear infections. It has been commonly seen in associated with or secondary to pulmonary tuberculosis. Clinical signs are often variable and different from classical descriptions. Therefore, laboratory studies are considered necessary for accurate diagnosis. Delayed diagnosis leads to delayed correct treatment, and followed by increased risk of complications such as permanent hearing loss or facial nerve palsy. In this report, we present a case of atypical tuberculosis manifestations after unsuccessfully long treating and excluding other infectious disorders of the ear. Biopsy during mastoidectomy procedure was performed for accurate diagnosis. Meanwhile, PCR result was negative for tuberculosis. Keywords: Tuberculosis, Otitis media

Introduction Tuberculosis is one of the most common infectious diseases in India. Tuberculosis of the middle ear is rare, usually seen in association with pulmonary tuberculosis or in patients with history of pulmonary tuberculosis. It is an uncommon and frequently misdiagnosed form of tuberculosis. In our experience, we have seen 50% of cases of tuberculous otitis media without pulmonary tuberculosis. These cases presented with rapid deterioration of hearing with more sensorineural component in hearing loss. Case Report This is a case report of 34-year-old woman presented to us with worsening of hearing over short duration of 3 months. She developed right profound hearing loss and left moderately severe mixed hearing loss, which deteriorated within duration of 2 weeks. Very few cases have been reported in literature affecting both the ears. In our experience, we have seen seven such cases with bilateral ear involvement. Conclusion Tuberculosis of the middle ear is a rare condition. For complete cure, medical therapy should be given at least for 9 months including 2 months 4 tablets (AKT4) and 7 months 3 tablets (AKT3) regimes, according to the INDEX-TB guidelines provided by government of India for extrapulmonary tuberculosis. Surgical treatment should be always added as emergency to prevent progression of sensorineural hearing loss and in cases of complications such as facial palsy.

Background: Tuberculosis is one of major health problems in developing countries, especially extrapulmonary tuberculosis. Tuberculous otitis media (TOM) is one of extrapulmonary manifestations which is a rare phenomenon characterized by painless otorrhea, insidious onset of ear discharge, multiple perforations in the tympanic membrane, and pale granulation tissues in middle ear cleft. Purpose: Reporting one rare case of TOM. Case Report: A 58-year-old male came with painless otorrhea and recurrent hearing impairment. Tympanomastoidectomy was carried out to repair the tympanic membrane, to cleanse the secret from the middle ear, and to obtain sample for biopsy. Histopathological examination showed necrotizing granuloma which contained mycobacterium tuberculosis infection. Medical treatment was administration of anti tuberculosis drugs. Clinical Question: How to establish TOM diagnosis? Review Method: Searching for literature evidence through Google Scholar. Result: The search obtained 20 journals which in accordance with the inclusion and exclusion criteria. There were similarities on clinical and therapeutic symptoms with this reported case. Discussion: In the reported case, the probable pathophysiology was bacterial aspiration through the Eustachian tube, which was just diagnosed during pre-operative screening. There was no apparent pulmonary tuberculosis symptom. Diagnosis TOM with mastoiditis was difficult, it required high skilled accuracy. Conclusion: TOM is a rare manifestation of extrapulmonary tuberculosis. High suspicion of TOM is needed in patients who did not respond to standard treatment. Treatment includes administration of anti-tubercular drugs, and surgical procedure to cleanse the secretion and granulation tissues. Permanent hearing loss can occur in cases of delayed diagnosis. ABSTRAK Latar belakang: Tuberkulosis merupakan masalah kesehatan di negara berkembang, terutama tuberkulosis ekstra pulmonal. Otitis media tuberkulosa (OMT) merupakan salah satu manifestasi tuberkulosis ekstra pulmonal yang jarang terjadi dan ditandai dengan gejala klinis berupa keluar cairan dari telinga tanpa disertai rasa nyeri, onset penyakit berjalan lambat, terdapat perforasi multipel pada membran timpani, dan jaringan granulasi pucat di rongga telinga tengah. Tujuan: Melaporkan satu kasus OMT yang jarang ditemukan. Laporan Kasus: Seorang laki-laki 58 tahun datang dengan keluhan keluar cairan dari telinga tanpa disertai rasa nyeri, dan ada gangguan pendengaran berulang. Pada pasien dilakukan tindakan bedah timpanomastoidektomi untuk memperbaiki membran timpani yang rusak, membersihkan sekret, dan melakukan biopsi jaringan. Hasil pemeriksaan histopatologi didapati jaringan granuloma nekrotikans yang menunjukkan adanya infeksi Mycobacterium tuberculosis. Diberikan terapi medikamentosa obat anti tuberkulosa. Pertanyaan Klinis: Bagaimana menegakkan diagnosa OMT? Telaah literatur: Penelusuran bukti kepustakaan melalui Google Scholar. Hasil: Penelusuran menghasilkan 20 jurnal yang memenuhi kriteria inklusi dan eksklusi dan memiliki kesamaan gejala klinis dan terapi dengan kasus yang dilaporkan. Diskusi: Pada kasus ini kemungkinan patofisologinya adalah aspirasi bakteri melalui tuba eustachius, dan OMT baru terdiagnosis saat dilakukan skrining pra-operasi. Tidak didapati gejala tuberkulosis paru. Diagnosis OMT dengan mastoiditis cukup sulit, diperlukan ketelitian yang tinggi. Kesimpulan: OMT merupakan manifestasi tuberkulosis ekstra pulmonal yang jarang terjadi. Perlu kecurigaan yang tinggi adanya OMT pada pasien yang tidak responsif terhadap pengobatan standar. Penatalaksanaan meliputi pemberian obat anti tuberkulosa, dan tindakan bedah untuk mengeluarkan dan membersihkan sekret dan jaringan granulasi. Gangguan pendengaran permanen bisa terjadi pada kasus yang penatalaksaannya terlambat.

Background: Tuberculous otitis media (TOM), a rare cause of chronic otitis media, is easily confused with nonspecific chronic otitis media owing to its unexpectedly changing and variable presentation, low suspicion and low prevalence which causes difficulty in its early diagnosis. The purpose of this study was to analyze its changing clinical pattern and to formulate an acceptable management protocol.Methods: This retrospective observational, descriptive study included 457 cases of Chronic otitis media who were operated between January 2017 to July 2020 in a tertiary care center. Histo-pathological examination of tissue from the middle ear and mastoid were sent and positive results were corroborated retrospectively to the clinical findings.Results: Diagnosis of TOM was established post-operatively in five cases (1.09%) with a positive histopathology report in four out of five cases and by polymerase chain reaction (PCR) in one case. Three cases (60%) presented with facial palsy and one with profound hearing loss (20%). All cases received 6 months course of anti-tubercular therapy postoperatively and were in regular follow up.Conclusions: Tuberculosis of the middle ear can present unexpectedly either as a complication or completely as a non-specific chronic otitis media. The extent of pathological findings might not be in commensuration with the clinical features. In operated chronic otitis media cases, specimen for histopathological examination must be sent in all cases and further specific microbiological investigations may as well be advised accordingly.

Objective: The aim of the study is to look for indicators of Tuberculous Otitis Media in all cases of chronic suppurative otitis media. Study Design: This is a retrospective study. Setting: This study was conducted in a tertiary care centre. Subjects and Methods: Detected cases of tuberculous otitis media (TBOM) cases studied retrospectively from January 2011 to December 2013 were included in the study. Investigations for tuberculosis were considered in the cases showing suspicious pale granulation tissue in the external auditory canal and middle ear and also in cases showing exuberant pale granulation tissue during mastoid surgery where Zeihl Nielson staining, histopathology, molecular genetic study was done. Cases showing positive result were included in the study. Results: During the study period 751 cases of CSOM were seen in outpatient room of which 18 cases of TBOM were diagnosed. Three patients were diagnosed preoperatively and 181 underwent surgery of which 15 cases were diagnosed positive, from the tissue obtained during the procedure. Direct smear was positive in four cases, concentration techniques in seven cases. Line probe assay was taken as diagnostic in all the cases. None of the cases were positive on histopathology. Conclusion: Tuberculous otitis media is often missed as the classical features are not seen in all cases of TBOM. The absence of these should not stop the clinician from diagnosing the disease. Suspicious tissue should therefore be tested properly to avoid missing the diagnosis and to prevent any complications.

Tuberculous otitis media (TOM) is a rare form of tuberculosis, due to tubercular otitis media, thick caseous material and granulation tissue gets deposited in middle ear cleft causing bone erosion, sequestration, ossicular destruction, heading loss which can be conductive or mixed and rarely facial paralysis. In this case report we discuss tubercular otitis media as a cause of recurrent facial nerve paralysis. 54 year old male patient with no known previous comorbidities presented to ENT OPD on 12 October 19 with complaints of scanty, mucopurulent foul smelling occasionally blood stained continuous otorrhoea (R)×02 years, painless progressive and persistent hearing loss ×1 year and recurrent (R) sided facial nerve palsy, 03 episodes in last 2 years which were spontaneous and sudden in onset, showed gradual recovery with oral medication. Tubercular otitis media is not a very common diagnosis with which an otolaryngologist comes across. It generally presents with otorrhea and hearing loss which mimics more commoner ear disease. Typical findings of multiple tympanic membrane perforations are not necessarily seen. There can be involvement of facial nerve and presence of refractory otorrhoea with atypical features may be considered indicative of tubercular pathology. A clinician should have high index of suspicion whenever there are signs which outlies symptoms in form of severity. This case highlights the diagnostic challenge and high index of clinical suspicion required for diagnosis. Combination of appropriate diagnostic modality along with good clinical vigilance will aid in early diagnosis and start of early medication which reduces chances of any subsequent complications.

Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis. While TB is predominantly pulmonary, 12–15% of reported cases of TB involve extrapulmonary sites. Rarely the temporal bone may be involved with TB – tuberculous otitis media or tuberculous otomastoiditis. Tuberculous otitis media are even rarer in developed countries and its incidence in the UK is said to be only 0.04% of cases of chronic otitis media. Tuberculous otitis media occur frequently in ears with pre-existing chronic middle ear infection where the organisms enter the middle ear through an existing tympanic membrane perforation. The classical description of tuberculous otitis media is painless otorrhoea, multiple perforations, pale granulations, early severe hearing loss and bone necrosis. While a positive culture for the acid-fast bacillus Mycobacterium tuberculosis confirms the presence of tuberculous otitis media, ear discharge provides a poor yield for positive cultures. This is believed to be due to the low bacterial count in the ear discharge.

Tuberculosis is one of the most common infections in the world. It is seen that tuberculous otitis media (TOM) is almost secondary to pulmonary tuberculosis. In this review we have tried to deal with all the aspects of the intra cranial complications of TOM such as tuberculoma, otitic hydrocephalus, brain abscess and tuberculous meningitis. The aspects covered in this review are the pathology, clinical features, and investigations of the intra cranial manifestations.

Tuberculous otitis media (TOM) can be difficult to diagnose because of its rarity, variable signs and symptoms, and nonspecific manifestations compared with other types of chronic otitis media (COM). Half of the cases have no other evidence of present or past infection, and its diagnosis is often delayed due to the rarity of this disease or its usually indolent course. A middle-aged female came with complaints of left-sided progressive facial weakness, intermittent left ear discharge, evening rise of fever, and hearing loss for 8 months and with a history of chronic cough, loss of appetite, and weight loss for last 1 month. On physical examination, she had left-sided grade V facial paralysis as per House–Brackmann grading system. X-ray of the chest showed prominent hilar shadow with cavitary lesion. A temporal bone computed tomography (CT) scan revealed left-sided mastoiditis. Sputum was found to be positive for acid-fast bacillus. Granulations with cheesy material were present in the mastoid cavity, which were positive for acid-fast bacillus with epithelioid giant cells. During the surgery, dehiscence of the fallopian canal was located in the second genu. The patient responded to antitubercular treatment. How to cite this article Bhardwaj P, Mohan C, Srivastava A. Tuberculous Otitis Media with Facial Paralysis. Int J Adv Integ Med Sci 2016;1(2):69-71.

Objective:Tuberculosis is a global health problem that is especially prevalent in developing countries such as India. Recently, atypical presentation has become more common and a high index of suspicion is essential. This study analysed the various presenting symptoms and signs of tuberculous otitis media and the role of diagnostic tests, with the aim of formulating criteria for the diagnosis.Methods:A total of 502 patients underwent tympanomastoidectomy over a two-year period. Microbiological and histopathological examinations and polymerase chain reaction analysis of tissue taken during tympanomastoidectomy were performed.Results:A total of 25 patients (5 per cent) were diagnosed with tuberculous otitis media. Severe mixed hearing loss, facial palsy, labyrinthine fistula, post-aural fistula, perichondritis and extradural abscess were noted.Conclusion:There seems to be a resurgence in tuberculous otitis media in India. Microbiological, histopathological and polymerase chain reaction tests for tuberculosis are helpful for its diagnosis.

Background: Tuberculosis remains a public health problem worldwide, and tuberculosis in pregnancy in particular can have effects on both mother and infant. Findings: We report a case of a 22- year-old female presenting in preterm labor at 32 weeks gestation. Her pregnancy had been complicated by hearing loss and weight loss, and at the time of delivery, she was diagnosed with tuberculous otitis media and disseminated tuberculosis. Tuberculous otitis media is a rare form of tuberculosis disease, and in this case, had consequences for mother and infant. Conclusions: Importance of suspicion for tuberculosis disease in patients presenting with atypical symptoms but epidemiologic history is emphasized.

We herein report a case of rare disease, Tuberculous otitis with unusual presentation, radiographic and pathologic findings. The granulations and bone erosion were extensive. He also developed extensive cold abscess in the pre-auricular region and rapid regrowth of granulations in the ear after mastoid exploration before starting anti TB treatment.

Tuberculous otitis media (TOM) is an uncustomary variety of tuberculosis (TB) usually seen secondary to pulmonary tuberculosis or associated with it. It is characterized by indolent and heterogeneous presentations. Diagnosis warrants clinical, radiological, and microbiological amalgamation. It is hence challenging and frequently delayed leading to disabling complications. Opportunate suspicion, timely diagnosis and appropriate antituberculosis therapy are the key to successful management. We report a unique case of bilateral TOM occurring in an immunocompetent adult.

Tuberculosis (TB) remains an important cause of infectious morbidity in the United States (US), necessitating timely and accurate diagnosis. We report a case of concurrent pulmonary and extrapulmonary TB presenting as tuberculous otitis media in a hospitalized US patient admitted with cough, night sweats, and unilateral purulent otorrhea. Diagnosis was made by smear microscopy and rapidly confirmed by Xpert MTB/RIF-a novel, automated nucleic acid amplification test for the rapid detection of drug-susceptible and drug-resistant TB. This case adds to the growing body of evidence validating Xpert MTB/RIF as an effective tool for the rapid diagnosis of extrapulmonary TB, even in low TB-prevalence settings such as the US, when testing is performed on non-respiratory specimens.

Tuberculous otitis media (TOM) is rare in ENT department, and is frequently misdiagnosed as otitis media. Thus early systemic treatment is very important for TOM. We reported a case report with TOM to highlight development of the disease and difficulties in clinical treatment in late stage of TOM. Implantation of ossified and eroded cochlea poses many unique challenges to both the surgeon and programming team. With thorough preparation and complete knowledge about characters of specific issues, implantation would be performed successfully, and patients with ossified cochlear could benefit from cochlear implantation.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Clinical symptoms are nonspecific making delayed diagnosis. We present the case of an infant, aged 22 months, having immune deficiency, who was admitted for a left externalized otomastoiditis. The radiological assessment confirmed this diagnosis. The child had a surgical drainage of the collection with biopsy of granulation tissue whose histopathological examination found a caseo-follicular tuberculosis. Despite its rarity, TOM is associated with a high rate of complications. The diagnosis should be considered in any suppurative chronic otitis resistant to standard treatment.

The incidence of tuberculosis in Japan, including tuberculous otitis media, has increased alarmingly. Predisposing factors remain, however, to be clarified—particularly in view of how clinical features have changed—with the use of effective antitubercular therapy and improved economic and social conditions. Otolaryngologists must thus be aware of tuberculous in chronic otitis media and its varied manifestations. We report the two cases of tuberculous otitis media and its presentation and clinical manifestation. Tuberculous otitis media diagnosis was corroborated by pathohistological, microbiological, and molecular biological tests.

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 patient had grown up in Russia, the other was a native-born American who had never left the East Coast region of the United States. Both patients had been symptomatic for many months; one complained of chronic otorrhea, and the other reported otorrhea, hearing loss, and discomfort. Neither patient responded to medical management, and both ultimately underwent surgery. One was diagnosed after surgical pathology revealed acid-fast bacilli on frozen-section analysis. In the other, pathology revealed chronic inflammation and granulomata, but stains were negative and her diagnosis was delayed for 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 of cases is rising in areas where tuberculosis is most common—that is, in major U.S. cities. Although 3 of these 9 cases occurred as reactivation disease in immigrants, most might have occurred as a result of local transmission. Clinicians should maintain a high degree of suspicion for tuberculosis in patients with chronic otitis symptoms, particularly those who are at higher risk of exposure to tuberculosis.

We report three cases of tuberculous otitis media. These cases, including a 54-year-old male, 17-year-old male and 41-year-old female, were initially diagnosed as acute otitis media at Miyazaki Medical College Hospital and a related hospital from 1978 to 2001. During the treatment, they exhibited atypical findings, such as painless otorrhea and necrosis of a tympanic membrane, and the antibiotics ordinarily used were not effective. Such clinical course suggested tuberculous otitis media, and then a definitive diagnosis was made. It is difficult to make an early diagnosis. Several clinical criteria published in recent years indicate that otoscopic findings are relatively unique for tuberculous otitis media. Therefore, it is important to recognize these characteristic findings as the signs of this disease.In the treatment of acute otitis media, we must keep in mind that tuberculous otitis media should be suspected if the patient shows intractable otorrhea without otalgia.

Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications.

Background: Tuberculosis has become a common occurrence in Otorhinolaryngology with increasing number of extra pulmonary cases. Methods: This is a study of 27 patients who visited ENT OPD of Dr. D. Y. Patil Medical College, Pune, with variety of manifestations of tuberculosis in the ENT region. Results: Majority of those suffered from tuberculous cervical lymphadenopathy, other manifestations included laryngeal tuberculosis, tuberculous otitis media, lupus vulgaris and tuberculous infection of a pre auricular sinus. FNAC and histopathologic examination proved to be reliable tools of diagnosis. Five of these patients suffered from concurrent pulmonary tuberculosis. All these responded well to category 1 anti-tubercular therapy well. Conclusions: Tuberculosis in Otorhinolaryngology shows a variety of manifestations so it should be kept in mind whenever dealing with unusual presentations.

Objective:To report a rare case of tuberculous otitis media, and to highlight barriers to clinical and microbiological diagnosis.Method:Case report and literature review.Results:Tuberculous otitis media is a rare cause of chronic ear infection in the UK. Its symptoms may mimic a range of other otological conditions, including otitis media, chronic suppurative otitis media, cholesteatoma and necrotising otitis media.Conclusion:This case report highlights the challenges of obtaining a clinical diagnosis of tuberculous otitis media, and emphasises the fact that screening for acid-fast bacilli is not sufficient, in isolation, to rule out mycobacterial infection.

Tuberculous otitis media is a rare disease, hence not often considered in the differential diagnosis of otorrhea. This results in late diagnosis with resulting complications such as irreversible hearing loss. A case report with review of the literature is presented, emphasizing that tuberculosis should be considered in the differential diagnosis of otorrhea not responding to commonly prescribed antibiotics. We also emphasize the importance of awareness creation in the management of such a disease, involving family members to oversee treatment and also research on ways of shortening duration of treatment to avoid default in treatment.

Objectives:To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases.Case report:We report four cases of tuberculous otitis media with different clinical presentations, encountered between 1998 and 2002. None of the cases showed improvement with local or systemic antibiotics. The diagnosis, complications and management of these cases are discussed.Conclusions:A high index of clinical suspicion of tuberculous otitis media is required in patients who do not respond to standard antibiotic therapy for (nontuberculous) chronic middle-ear infection. Early diagnosis and treatment of tuberculous otitis media is important to avoid irreversible complications, surgical intervention and propagation of the disease.

Because the suspicion of tuberculous otitis media is low and clinicians are no longer encountering the typical classical features of the disease on a regular basis, there is frequently a considerable delay prior to diagnosis. For that reason, a description of modern features is needed. We report a case of postoperationally diagnosed tuberculous otitis media. The patient had not experienced any otalgia even though the left tympanic membrane had a central perforation. The observation of the tympanic membrane after tympanoplasty revealed that the painless perforation of the tympanic membrane could have been a sufficient feature to indicate tuberculous otitis media. The administration of oral antituberculous drugs can be effective therapy even if the diagnosis is made after tympanoplasty.

We report a case of tuberculous otitis media in a 68-year-old man. The patient complained of left otorrhea, right otalgia and hearing loss. Chronic otitis media was suspected on his first visit, but Ziel-Neelsen staining of the aural discharge resulted in a diagnosis of tuberculous otitis media. Treatment with INH and RFP led to complete healing.In the diagnosis of middle ear infections, it is necessary to bear in mind the possibility of tuberculous and to carry out Ziel-Neelsen staining if there is massive otorrhea in the ear canal. Examination for tuberculous should be done before medication with the new quinolones, some of which are effective against tuberculous.

The case of a 34-year-old man with tuberculous otitis media is reported. He presented with a first chief complaint of deafness in the left ear. A simple central perforation without transdate and without granulation tissue was noted. A tympanoplasty was carried out under the diagnosis of simple otitis media, and it revealed that the cavity from the attic to the mastoid antrum was occupied by a mass of granulation tissue. Since this characteristic finding was found during surgery, tuberculous otitis media was strongly suspected. A tuberculin test, a smear test of the bacterial specimen of the ear transdate and a histopathological examination of the granulation tissue by Zeel-Neelsen stain yielded negative results. However acid fast bacilli were cultured from the sputa and aural discharge. Pulmonary tuberculosis with tuberculous otitis media was finally diagnosed and the patient was treated with adequate antituberculous medication. Most of the tuberculous examination showed negative results in the patient. The only one positive finding was the granulation tissue in the middle ear cavity, which was detected by surgery. It is necessary to repeated lyexamine the ear, and to keep in mind tuberculous otitis media if massive granulation tissue is detected in the middle ear cavity during surgery.