Bilateral Tuberculous Otitis Media: A Rare Presentation

Abstract

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.

Keywords

tuberculous otitis media - AKT4 - AKT3 - INDEX-TB guidelines

• References

• 1 Odetoyinbo O. Early diagnosis of tuberculous otitis media. J Laryngol Otol 1988; 102 (02) 133-135
• 2 Granato L, Limae SilvaLA. Tuberculous otitis media. Rev Bras Otorrinolaringol 1973; 39: 125-132
• 3 Skolnik PR, Nadol Jr JB, Baker AS. Tuberculosis of the middle ear: review of the literature with an instructive case report. Rev Infect Dis 1986; 8 (03) 403-410
• 4 Plester D, Pusalkar A, Steinbach E. Middle ear tuberculosis. J Laryngol Otol 1980; 94 (12) 1415-1421
• 5 Benedict RF, Cruz OLM, Morimoto E, Ramos CC, Siebert D, Miniti A. Tuberculosis of the temporal bone. Current state and presentation of 2 cases. Rev Bras Otorrinolaringol 1987; 53: 90-95
• 6 Windle TaylorPC, Bailey CM. Tuberculosis otitis media. Laryngoscope 1980; 90: 1039-1044
• 7 Sharan R, Isser DK. Primary tubersxculosis of the middle ear cleft. Practitioner 1979; 222 1327 93-95
• 8 Vijayendra H, Parikh B. Bone conduction improvement after surgery for conductive hearing loss. Indian J Otolaryngol Head Neck Surg 2011; 63 (03) 201-204
• 9 Awan MS, Salahuddin I. Tuberculous otitis media: two case reports and literature review. Ear Nose Throat J 2002; 81 (11) 792-794
• 10 Chirch LM, Ahmad K, Spinner W, Jimenez VE, Donelan SV, Smouha E. 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. Ear Nose Throat J 2005; 84 (08) 488-490 490, 492 passim
• 11 Sens PM, Almeida CI, Valle LO, Costa LH, Angeli ML. Tuberculosis of the ear, a professional disease?. Rev Bras Otorrinolaringol (Engl Ed) 2008; 74 (04) 621-627
• 12 Vaamonde P, Castro C, García-Soto N, Labella T, Lozano A. Tuberculous otitis media: a significant diagnostic challenge. Otolaryngol Head Neck Surg 2004; 130 (06) 759-766