Tuberculous Otitis Media: a case report of hearing impairment in developing country

ABSTRACTBackground: 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. ABSTRAKLatar 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.

Unusual presentation of tubercular mastoid cyst

Tuberculosis in the otomastoid compartment is extremely rare. The classical presentation of tuberculous otitis media includes chronic otorrhea, severe hearing loss irrespective of the disease, multiple perforations, and pale granulations in the middle ear cavity. However, most present with non-specific signs and symptoms making it a diagnostic dilemma. Here, we report a case that presented with a bony mastoid cyst which is the first case report to the best of our knowledge. A 12-year-old boy visited our center with a complaint of chronic ear discharge and hearing loss not improving with conventional antibiotic therapy. The computed tomography scan of the temporal bone revealed soft tissue opacification in the mastoid along with features suggestive of cholesteatomatous chronic otitis media. The patient underwent mastoidectomy under general anesthesia, which revealed a bony mastoid cyst filled with turbid fluid along with granulation tissues in the middle ear cleft without cholesteatoma. Final histopathology revealed tuberculous otitis media. Antitubercular chemotherapy was started and the patient’s condition recovered. Primary tuberculous mastoiditis is a rare clinical entity that requires a high index of suspicion. It can also present as chronic otorrhea with mastoid cyst, and thus need to be considered as one of the differential diagnoses.

Tuberculous Otitis Media Complicated by Meningitis-Induced Bilateral Sensorineural Hearing Loss: A Case Report

Tuberculosis of the middle ear is a rare but treatable disease; however, delays in diagnosis and treatment usually lead to complications. Diagnosis is made difficult by most physicians being unfamiliar with the typical presenting features and special cultural and pathologic studies being required for diagnosis. A case report and literature review are presented, illustrating typical clinical, epidemiologic, and laboratory features, as well as complications and the treatment of tuberculous otitis media.