South Korean researchers have reported a rare case of tuberculous otitis media (TOM) and say that ear tuberculosis should be considered in patients presenting with otitis media complicated by facial paralysis.
The case, reported in the Korean Journal of Audiology by June Choi (Korea University Ansan Hospital, Seoul) and co-workers, was a 44-year-old woman who presented with a 3-month history of intermittent discharge from the left ear and a 7-day history of progressive left facial paralysis, dizziness and hearing loss.
Examination revealed severe facial paralysis, total perforation of the tympanic membrane, oedema of the middle ear mucosa and discharge from the left ear. Initial cultures of ear discharge were negative.
Further evaluation revealed that she was deaf in the left ear due to dehiscence of the tympanic segment of the facial nerve. Preoperative electroneurography demonstrated 75% degeneration of this nerve.
She underwent surgery during which a significant amount of granulation tissue was removed from the middle ear and mastoid; she also underwent facial nerve decompression.
Histology revealed numerous bacilli, and polymerase chain reaction testing of the middle ear mucosa was positive for Mycobacterium tuberculosis. She was started on a four-drug anti-tuberculosis oral drug regimen and by day 7 postoperatively her dizziness had resolved.
Her facial paralysis improved slowly and had resolved completely by 4 months. Her hearing threshold was unchanged at 6 months postoperatively, however, and she remained deaf in the left ear.
Commenting on the case, Choi and co-workers say that TOM was first reported in 1853 but is a very infrequent cause of chronic otitis media and as such is rarely considered in the differential diagnosis.
The pathogenesis of TOM is also controversial, with three major hypotheses being proposed: aspiration of mucus through the auditory tube; hematogenous transmission from other tuberculosis foci; and direct implantation through the external auditory canal with tympanic membrane perforation.
The team concludes: “[A]lthough TOM is a rare entity, otologic surgeons should be vigilant for suggestive clinical signs such as painless otorrhea, abundant granulation tissue, facial paralysis, or a family history of tuberculosis. Including this disease in the differential and considering it will lead to prompt treatment and prevention of serious sequelae.”
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