Tuberculous Otomastoiditis: A Diagnostic Dilemma

Area of Science:

• Otolaryngology
• Infectious Diseases
• Radiology

Background:

• Tuberculous otomastoiditis (TOM) is a rare complication of tuberculosis, often presenting as a chronic discharging ear resistant to standard treatments.
• High index of suspicion is necessary for diagnosis, especially in endemic areas.

Observation:

• A case of TB otomastoiditis with a deep neck abscess in an 18-year-old male is presented.
• The patient exhibited chronic otorrhea, hearing loss, and neck swelling, with initial cultures negative for acid-fast bacilli.
• High-resolution computed tomography (HRCT) revealed extensive bony erosion and soft tissue occupation of the middle ear and mastoid.

Findings:

• Diagnosis of TB otomastoiditis was confirmed by positive Mycobacterium tuberculosis culture from surgical specimens, despite negative AFB stains.
• The patient showed complete resolution after three months of anti-tuberculosis treatment.

Implications:

• Early HRCT and high clinical suspicion are vital for timely diagnosis and treatment of TB otomastoiditis.
• Surgical intervention may be necessary for diagnosis, disease debridement, and management of complications.
• Bone conduction hearing aids may be considered for persistent hearing loss.