Aural tuberculosis

Tuberculous otitis media can present with very nonspecific clinical features. Five cases of tuberculous otitis media are reviewed over a period of 5 years. Significant clinical findings included the presence of abundant granulation tissue in mastoids with good pneumatization, cervical lymphadenopathy, profound hearing loss, facial palsy, and foci of tuberculous infection at other sites. Histologic examination of granulation tissue showed tuberculoid granulomata in all cases. The mycobacteria could be identified in two of the biopsies but not on cultures. Other conditions that give rise to tuberculoid granulomata should be searched for in cases where the myobacteria cannot be identified. In one case, diagnosis was delayed because the operative specimen was neither histologically examined nor sent for culture. Persistent otorrhea and recurring granulomata after mastoidectomy provided other important clinical features. All cases responded well to antituberculous chemotherapy. Surgery is indicated nowadays for facial palsy, subperiosteal abscess, fistula formation, labyrinthitis, intracranial complication, or infrequency for resistant mycobacterial infection caused by the non-tuberculous mycobacteria.