Tuberculosis in the head and neck: experience in India

Area of Science:

• Otolaryngology
• Infectious Diseases
• Oncology

Background:

• Tuberculosis (TB) incidence has declined in developed nations due to improved conditions and anti-TB therapy.
• Extra-pulmonary TB presentations are increasingly common, particularly with the human immunodeficiency virus (HIV) epidemic.
• Otolaryngologists must be aware of diverse head and neck tuberculosis manifestations.

Purpose of the Study:

• To report the increased incidence of isolated head and neck tuberculosis.
• To describe the varied presentations and clinical manifestations of head and neck TB over a 10-year period.

Main Methods:

• A 10-year retrospective study (1995-2004) of 165 head and neck TB patients.
• Detailed clinical examination and investigations were performed.
• Treatment included anti-tubercular therapy (ATT), with surgery for some cases; anti-retroviral therapy and radiotherapy were used for co-existing HIV and malignancy, respectively.

Main Results:

• Isolated tubercular lymphadenitis was most common (73.3%).
• Other sites included larynx (14.5%), oral cavity (5%), and otitis media (2.4%).
• Fine needle aspiration cytology (FNAC) was effective for lymphadenitis (92%), but histopathology was needed for other sites. Purified protein derivative (PPD) test sensitivity was low (20%).
• 24.2% had coexisting pulmonary TB, 3% had malignancy, and 30% of tested patients had HIV.

Conclusions:

• Head and neck TB can manifest as isolated disease beyond cervical lymphadenitis.
• Seventy-five percent of patients lacked pulmonary involvement.
• FNAC is useful for nodal TB, while histopathology is crucial for other head and neck sites. PPD test is unreliable.
• Early diagnosis hinges on clinical suspicion and investigations; successful outcomes depend on chemotherapy and timely surgical intervention.