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Otopathology of Pediatric Acute Tuberculous Meningitis-Case Series

Natalia Carasek1,2,3, Lucas Alves Teixeira Oliveira1,2,3, MengYu Zhu2

  • 1Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|July 30, 2026
PubMed

Insights

Tuberculous meningitis (TBM) causes sensorineural hearing loss (SNHL) by damaging the infant inner ear. Pathways like the cochlear aqueduct facilitate Mycobacterium tuberculosis spread.

Area of Science:

  • Neurology
  • Pathology
  • Otolaryngology

Background:

  • Tuberculous meningitis (TBM) is a severe Mycobacterium tuberculosis infection.
  • TBM can lead to sensorineural hearing loss (SNHL).
  • The exact pathophysiology of SNHL in TBM is not fully understood.

Purpose of the Study:

  • To investigate the pathological changes in the inner ear of infants who died from TBM.
  • To identify potential routes of Mycobacterium tuberculosis dissemination to the inner ear.

Main Methods:

  • Histopathological examination of 3 infant temporal bones from TBM cases.
  • Analysis of inner ear structures and the internal auditory canal.

Main Results:

  • Observed acute inner ear damage including cochlear fibrosis, organ of Corti atrophy, and neuronal loss.
  • Found abundant mononuclear cells in the internal auditory canal.
  • Identified the cochlear aqueduct, endolymphatic sac/duct, and Rosenthal's canal as potential routes of spread.

Conclusions:

  • TBM causes direct acute damage to the infant inner ear.
  • Specific anatomical pathways facilitate the spread of infection from the subarachnoid space to the inner ear in TBM.
  • Understanding these pathways is crucial for addressing SNHL in TBM.
Keywords:
Hearing lossOtopathologyTuberculosisTuberculous meningitis

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