Bezold's abscess in tuberculous otitis media: An extremely rare case report and literature review

Bezold's abscess is a rare complication of chronic suppurative otitis media since the advent of antibiotics. Otitis media can also result from uncommon infections such as tuberculosis, with a diagnosis often delayed due to clinical symptoms that closely resemble other chronic middle ear conditions.

We present a case of Bezold's abscess as a complication of primary tuberculous otitis media in a 21-year-old male who reported right-sided neck swelling for four days, accompanied by fever, difficulty opening his mouth, and a history of persistent purulent discharge in both ears for six months that did not respond to topical antibiotics.

This case underscores the diagnostic challenges of tuberculous otitis media, an unusual form of extrapulmonary tuberculosis that can closely mimic other types of chronic otitis media. The atypical presentation and low incidence of TOM contribute to frequent delays in diagnosis, highlighting the need for increased clinical vigilance, particularly in cases of persistent otorrhea unresponsive to standard antimicrobial therapy. Prompt recognition and initiation of appropriate antituberculous treatment, along with surgical intervention when indicated, are essential to prevent severe complications. This case illustrates the importance of considering TOM in the differential diagnosis of chronic ear infections and the value of advanced diagnostic modalities in facilitating early and accurate identification.

Tuberculous otitis media should be considered when optimal treatment regimens fail to achieve expected outcomes. Prompt diagnosis is essential in avoiding delays in treatment, which can lead to severe complications such as Bezold's abscess.