Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective

Area of Science:

• Otorhinolaryngology
• Infectious Diseases
• Public Health

Background:

• Extrapulmonary tuberculosis (EPTB) incidence is rising due to immunocompromised states and resistant bacteria.
• Clinical manifestations of head and neck EPTB overlap with malignancies and other ENT diseases, necessitating accurate early diagnosis.
• The Revised National Tuberculosis Control Program (RNTCP) provides guidelines for anti-tuberculous treatment (ATT).

Purpose of the Study:

• To determine the clinical manifestations and epidemiology of head and neck EPTB in otorhinolaryngeal regions.
• To highlight the importance of early diagnosis and appropriate treatment for EPTB in the head and neck.

Main Methods:

• A prospective study was conducted on 45 patients diagnosed with EPTB of the otorhinolaryngeal regions.
• Patients attended the Ear, Nose, and Throat (ENT) Outpatient Department (OPD) at a tertiary care center in Southern India over 18 months.

Main Results:

• Cervical lymphadenopathy was the most common presentation (64.4%), followed by tuberculous laryngitis (24.4%).
• Other presentations included tuberculous otitis media (6.6%), and nasal and oral cavity tuberculosis (2.2% each).
• Comorbidities included co-existing pulmonary tuberculosis (13.3%), diabetes (18%), a past history of tuberculosis (11%), and contact with a tuberculosis patient (16%).

Conclusions:

• A high index of suspicion for EPTB is required when symptoms are disproportionate to signs, common treatments fail, or symptoms persist/recur.
• Histopathological examination (HPE) is crucial for confirming the diagnosis.
• Timely diagnosis and initiation of ATT as per RNTCP guidelines lead to complete recovery and reduced morbidity.