Profile of paediatric tuberculosis mastoiditis - a case series

Area of Science:

• Otolaryngology
• Pediatric Infectious Diseases
• Radiology

Background:

• Tuberculosis otitis media, a rare extrapulmonary form of TB, often presents as complicated tuberculosis mastoiditis (TBM).
• TBM is uncommon in children, even in TB-endemic regions, and delayed diagnosis can lead to significant morbidity.
• This case series aims to increase awareness and outline diagnostic and management strategies for TBM in pediatric patients.

Purpose of the Study:

• To describe the clinical characteristics of tuberculosis mastoiditis in children.
• To highlight diagnostic and management fundamentals for TBM in pediatric cases.
• To emphasize the importance of early identification to prevent severe morbidities.

Main Methods:

• Retrospective chart review of five pediatric TBM cases at a South African hospital over five years.
• Collected data included symptomatology, disease duration, investigations, and management.
• Clinical and radiological information from temporal bone CT scans was analyzed.

Main Results:

• All five patients were under five years old and initially presented with acute bacterial mastoiditis symptoms.
• Radiological findings included extensive bony destruction and intracranial extension in some cases.
• Hearing loss was common, ranging from mild to profound, and necrotizing granulomatous inflammation was confirmed histologically.

Conclusions:

• Delayed diagnosis of TBM in children leads to significant bony destruction and hearing loss.
• Prompt tissue sampling for microscopic, PCR, and histologic analysis is vital for accurate diagnosis and to potentially avoid mastoidectomy.
• In TB-endemic areas, suspected TBM cases with characteristic findings warrant early anti-TB treatment initiation pending definitive diagnosis.