Primary tuberculosis of the middle ear cleft

Diagnostic and therapeutic considerations

Balázs Liktor, Bálint Liktor, Bálint Liktor, Judit Kálmán, Barnabás Horváth, I. Sziklai, T. Karosi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Tuberculosis remains one of the most challenging infectious diseases, which rarely manifests in the middle ear cleft exclusively. Typical symptoms of tuberculosis have become more and more confusing due to the genetic evolution of different Mycobacterium species. In the diagnosis of tuberculous otitis media (TOM), clinical suspicion plays a fundamental role, when topical and/or systemic antibiotic treatment cannot lead to improvement in ear discharge and inflammation. If there is no other reason of persisting otorrhea, microbiological sampling and culturing are the subsequent steps of diagnosis. These investigations, however, have low sensitivity; therefore a canal wall-up mastoidectomy is recommended, which includes the removal of necrotic bone and multiple histological sampling from various locations. Currently, histopathological analysis is the most robust and reliable method in the diagnosis of TOM. Tuberculin skin test, Mycobacterium-specific PCR and interferon-gamma release assay cannot distinguish between active, inactive or post-infective conditions. According to these considerations, these methods may serve as supplementary assays for the final diagnosis. Having the appropriate diagnosis after surgical intervention and laboratory analysis, medical management should be continued by anti-tuberculosis chemotherapy. Hereby, we demonstrate two cases with primary TOM and provide an overview of the literature in the light of diagnostic and therapeutic guidelines in the management of TOM.

Original languageEnglish
Pages (from-to)2083-2089
Number of pages7
JournalEuropean Archives of Oto-Rhino-Laryngology
Volume271
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Middle Ear
Otitis Media
Tuberculosis
Mycobacterium
Interferon-gamma Release Tests
Therapeutics
Otitis
Tuberculin Test
Molecular Evolution
Skin Tests
Communicable Diseases
Guidelines
Anti-Bacterial Agents
Bone and Bones
Drug Therapy
Polymerase Chain Reaction

Keywords

  • Mastoidectomy
  • Middle ear cleft
  • Otitis media
  • Tuberculosis

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Medicine(all)

Cite this

Primary tuberculosis of the middle ear cleft : Diagnostic and therapeutic considerations. / Liktor, Balázs; Liktor, Bálint; Liktor, Bálint; Kálmán, Judit; Horváth, Barnabás; Sziklai, I.; Karosi, T.

In: European Archives of Oto-Rhino-Laryngology, Vol. 271, No. 7, 2014, p. 2083-2089.

Research output: Contribution to journalArticle

Liktor, Balázs ; Liktor, Bálint ; Liktor, Bálint ; Kálmán, Judit ; Horváth, Barnabás ; Sziklai, I. ; Karosi, T. / Primary tuberculosis of the middle ear cleft : Diagnostic and therapeutic considerations. In: European Archives of Oto-Rhino-Laryngology. 2014 ; Vol. 271, No. 7. pp. 2083-2089.
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