Clinical case of tuberculous otitis media in an adolescent with generalised tuberculosis

Abstract

Since the incidence of tuberculosis (TB) of the middle ear is low, alertness to this condition among physicians is decreased. The absence of specific clinical signs of the disease results in the late diagnosis of tuberculous otitis media, the development of irreversible changes and extracranial or intracranial complications, which leads to patients' disabilities. The clinical example has demonstrated the development of tuberculous otitis media in the patient with chronic nonspecific inflammation in the middle ear and infiltrative pulmonary TB. The absence of pathognomonic signs led to the late diagnosis of tuberculous otitis media and, consequently, the development of bilateral mesotympanitis. Tuberculous etiology of the disease was suspected based on the case history analysis (drug-refractory chronic otitis media and exposure to TB), clinical and laboratory data (the absence of expressed pain syndrome and normal hemogram values along with expressed changes in the middle ear), active long-lasting pulmonary TB, positive immunological skin test results. The diagnosis was verified by microbiological detection of M. tuberculosis in the ear discharge. Complex treatment of the patient resulted in clinical cure of tuberculous otitis media after 18 months; infiltrative TB led to the development of a tuberculoma after 8 months. The late diagnosis of the disease resulted in surgical treatment (bilateral tympanoplasty, resection of two segments of the left lung).