Middle ear tuberculosis: diagnostic criteria

Area of Science:

• Otolaryngology
• Infectious Diseases
• Radiology

Background:

• Tuberculous otitis media presents diagnostic challenges due to difficulties in obtaining definitive microbiological, histomorphological, and cytological confirmation.
• Distinguishing tuberculous otitis from other chronic otitis media forms, like cholesteatoma, is crucial for appropriate management.

Purpose of the Study:

• To compare clinical and radiological characteristics of tuberculous otitis with cholesteatoma.
• To identify diagnostic criteria for tuberculous otitis by analyzing otogenic complications and disease presentation.

Main Methods:

• Retrospective analysis of medical records for 12 tuberculous otitis and 163 cholesteatoma patients.
• Evaluations included otomicroscopy, audiology, temporal bone and thorax radiology, secretion microbiology, and surgical tissue histomorphology.
• Statistical analysis employed the chi-squared test with Yates correction.

Main Results:

• Tuberculous otitis patients exhibited higher frequencies of otogenic complications, including facial palsy and sensorineural hearing loss.
• Labyrinthine fistulas and facial canal bone destruction were more prevalent in tuberculous otitis.
• CT scans revealed extensive temporal bone destruction in half of tuberculous otitis cases; one-third had coexisting miliary pulmonary tuberculosis.

Conclusions:

• Tuberculous otitis media should be suspected in patients with severe otogenic complications, short ear discharge duration, coexisting miliary pulmonary tuberculosis, and extensive temporal bone destruction.
• Current diagnostic methods, including polymerase chain reaction, lack definitive reliability for tuberculous otitis.