MIDDLE EAR MUCOSA TUBERCULOSIS: A RARE CASE

Dr. Sunita Singh, Dr. Sakshi Dahiya, Dr. Bharti Sharma*, Dr. Rajeev Sen

ABSTRACT

Tuberculosis is a widely prevalent disease in developing countries. Tuberculous otitis media is a rare form of presentation of chronic otitis media and extrapulmonary Tuberculosis. Middle ear mucosa tuberculous infection can be acquired by hematogenous route and rarely by infection through middle ear perforation. The typical symptoms and signs which the patient presents with, include multiple perforations of the tympanic membrane, painful ear discharge, preauricular lymphadenopathy, sensorineural hearing loss and associated constitutional symptoms. Diagnosis is tricky because the cultures are usually negative and positive acid-fast bacilli smears are uncommon too. Also, histopathological examination rarely shows tubercular granulomas but more frequently indicate necrotising granulomas, if any. A case of 20 year old male, who presented with the complaint of on and off bilateral ear discharge since childhood, who clinically diagnosed as having bilateral chronic suppurative otitis media and his middle ear mucosa biopsy was taken and processed, microscopic examination done and biopsy comprised of mature cartilaginous tissue and soft tissue which was infilterated by mononuclear cells along with epithelioid cell granulomas, revealing focal necrosis. This was suggestive for tuberculosis. Tuberculosis is the most common infection worldwide. Fortunately, TB of the middle ear and temporal bone are rare. Disease is usually unilateral but this patient had bilateral ear involvement. Treatment includes surgical options like tympanoplasty and radical mastoidectomy. Tuberculosis of the ear is difficult to diagnose on biopsy but once established, it responds well to therapy. Hence treatment should be early and prompt so as to avoid other complications.

Keywords: Tuberculosis, Middle ear mucosa, chronic suppurative otitis media.