Middle Ear Tuberculosis
Key Points
- Accounts for 0.04-0.9% of all chronic suppurative otitis media cases in children
- Usually secondary to pulmonary TB through Eustachian tube spread
- Multiple perforations coalescing into single large perforation is pathognomonic
- Early diagnosis crucial to prevent complications like facial paralysis
Pathophysiology
Middle ear TB typically occurs through:
- Ascending infection via Eustachian tube (most common)
- Hematogenous spread
- Direct extension from adjacent structures
Clinical Presentation
Early Stage
- Painless otorrhea (watery, purulent)
- Multiple tympanic membrane perforations
- Pale granulation tissue in middle ear
- Conductive hearing loss
Advanced Stage
- Single large central perforation
- Abundant granulation tissue
- Bone erosion and necrosis
- Facial nerve paralysis (in 16-35% cases)
- Preauricular lymphadenopathy
Diagnostic Approach
Essential Investigations
- Otoscopic examination
- Ear swab for:
- AFB smear
- Gene Xpert MTB/RIF
- Culture and sensitivity
- Biopsy of granulation tissue for histopathology
- Pure tone audiometry (age-appropriate)
- High-resolution CT temporal bone
Supportive Investigations
- Chest X-ray
- Mantoux test
- ESR and CRP
- HIV testing
Treatment Protocol
Medical Management
- Anti-tubercular therapy (ATT):
- Intensive phase (2 months): HRZE
- Continuation phase (4-7 months): HR
- Total duration: 6-9 months based on response
- Regular aural toilet
- Topical antibiotic-steroid drops
Surgical Management
- Usually delayed until 6-8 weeks of ATT
- Indications:
- Persistent granulations
- Facial nerve decompression
- Ossicular chain reconstruction
- Mastoid surgery for complications
Complications and Monitoring
Common Complications
- Permanent hearing loss
- Facial nerve paralysis
- Labyrinthitis
- Petrous apicitis
- Intracranial spread
Monitoring Parameters
- Monthly audiological assessment
- Regular otoscopic examination
- Facial nerve function monitoring
- Treatment response assessment
Prognosis Factors
- Early diagnosis
- Compliance with ATT
- Extent of disease at presentation
- Presence of complications
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
