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Tuberculous otomastoiditis: A therapeutic and diagnostic challenge

Context and Aims: Tuberculosis (TB) has affected mankind since time immemorial. Extrapulmonary TB poses special diagnostic and therapeutic challenges. Temporal bone is an extremely rare target organ for tuberculous infection. It constitutes just 0.05%–0.9% of all chronic middle ear otitis cases. However, because of its rarity, it is often missed as a diagnosis, and thus there is a significant delay in initiating the treatment. The aim of this study was to identify the cases of tuberculous otomastoiditis (TOM) in patients undergoing middle ear surgery in a tertiary care hospital. Settings and Design: This was a retrospective chart review carried out in a tertiary care hospital. Materials and Methods: Nine hundred and fifty charts of patients undergoing middle ear surgery were studied. Three cases of TOM were identified. Results: All the patients had painless otorrhea and hearing loss as the presenting feature. Only one patient had facial nerve palsy. During the initial phase of management, TB was not suspected in any of the patients. Histopathological examination (HPE) of the tissue obtained at surgery provided the diagnosis in all the cases. The response to antitubercular treatment (ATT) was satisfactory in all three cases. Conclusions: TB should always be kept as a differential diagnosis in case of chronic middle ear infection, especially if there is a poor response to antibacterial treatment. HPE of the tissue and specific microbiological testing are the gold standard for diagnosis. The primary treatment in these cases is ATT with a limited role of surgery.