Tuberculosis - I. T. Pyatnochka 2005

Extrapulmonary tuberculosis
Tuberculosis of the ear

This specific lesion of the outer, middle, or Inner ear is quite rare and usually develops as a complication of secondary tuberculosis. However, cases of Primary tuberculosis of the Middle ear do occur. Mycobacterium tuberculosis enters the ear via hematogenous, lymphogenic, intracanalicular (through the Eustachian tube), and contact routes.

Tuberculosis of the External ear is uncommon, most frequently appearing in association with lupus vulgaris of the facial Skin. The clinical forms include tuberculid of the earlobe or other areas of the external ear, infiltrative or ulcerative lupus, scrofuloderma, and tuberculous perichondritis.

Tuberculosis of the external auditory canal manifests as deep or extensive ulcers and is typically a complication of middle ear tuberculosis.

Tuberculosis of the middle ear is more frequently observed in children and adolescents, and less commonly in adults with active Pulmonary Tuberculosis. The onset of the disease can be acute, subacute, or chronic. Acute and subacute forms are characterized by a sudden onset, earache, and Hearing loss. Chronic forms are typically marked by progressive hearing loss, often accompanied by tinnitus, and a painless onset of otorrhea. The tympanic membrane appears infiltrated and hyperemic, studded with tubercles, and often features one or multiple large perforations. Subsequently, granulations and polyps (which frequently recur after removal), fistulas, bone caries, and Facial Nerve palsy may develop. Tuberculous mastoiditis is a relatively rare complication, especially in adults.

Tuberculosis of the inner ear is an extremely rare complication characterized by a slow, often asymptomatic development and clinical course. Occasionally, sudden deafness occurs. Vestibular disorders, dizziness, balance disturbances, and The Development of Tuberculous meningitis are also possible.

The Diagnosis of tuberculous otitis is based on the clinical and otoscopic presentation, confirmed by bacteriopathological and Bacteriological examination OF ear discharge, as well as histological analysis of biopsy material (such as granulations).

Diagnosing primary tuberculosis of the inner ear is significantly more challenging.

Cytology/practical/136.html">Differential diagnosis OF tuberculous otitis media should primarily be performed to rule out non-specific chronic otitis and cholesteatoma.

Treatment is carried out using isoniazid in combination with rifampicin, pyrazinamide, and ethambutol, similarly to category I patients. Combining antimycobacterial therapy with topical treatments proves quite effective. A 2% solutizone solution with hydrocortisone (3–4 drops three times daily for 3–4 weeks) is commonly applied. In selected cases, surgical intervention is necessary (mastoidectomy, abscess drainage, removal of granulations and polyps).