Abstract

Background: Tuberculosis is a chronic granulomatous disease that can affect any part of the body. Being endemic in India tuberculosis must be included in the differential diagnosis of chronic otitis media not responding to usual antibiotics. The diagnosis is more likely in the setting of patients on immunosuppressive therapy, patients receiving steroids or patients with past or family history of tuberculosis. In many cases tuberculous otitis media is not diagnosed mainly because it is often not suspected. We conducted this disease to study the tubercular otitis media, its clinical features, examination findings, intra-operative appearance and for knowing up to what extent an early diagnosis and intervention could restore normal hearing in these patients.

Aims and Objectives: To study the patients of tubercular otitis media and their clinical presentations, clinical examination, intraoperative findings and incidence of deafness in patients having tubercular otitis media.

Material and Methods: This was a multi-centric prospective cohort study comprising of 60 patients who attended ENT department of a medical college and a well known ENT centre situated in an urban area. The study period spanned over 2 years. All patients presenting with chronic ear disease who have not responded to routine antibiotic therapy were included in this study if they met inclusion criteria like presence of multiple tympanic membrane perforations and presence of pale granulation tissue in external auditory canal. In all patients detailed history was taken, including past and family history of tuberculosis. Degree of hearing loss was assessed by pure tone audiometry. Patients were screened for presence of tubercular focus elsewhere in the body (chest X-ray, montoux and ESR). Surgical intervention comprised of mastoidectomy and removal of granulation tissue. Tympanic membrane grafting was done using temporals fascia. Ossiculoplasty was done if required. Later patients were discharged on 3rd postoperative day and were called up for follow up and suture removal on day-8. Antitubercular treatment was started after consultation with the chest/TB physician.

Results: Total 60 patients with tubercular otitis media conforming to the inclusion criteria were included in this study. Out of these 60 patients there were 34 males (56.66%) and 26 (43.33%) were females with a M:F ratio of 1: 0.76. The most common age group affected was 30-40 years in males as well as females. The most common symptoms found in the studied cases were discharge from ear followed by diminished hearing and tinnitus. The commonest clinical finding seen in studied cases was central perforation with granulation tissue in middle ear followed by edema of external auditory canal with granulations and perforation of tympanic membrane with discharge. Preoperative hearing loss was severe in 30 patients while mild and moderate hearing loss was seen in 8 and 18 patients respectively. Profound hearing loss was seen in 4 patients. During operative procedure the most common findings observed were pale fibrotic granulation tissue, erosion of ossicular chain and mastoiditis.  Postoperatively hearing was fully restored in 16 patients. While mild, moderate, severe and profound hearing loss was seen in 28, 10,4 and 2 patients.

Conclusion: Tubercular otitis media is a rare form of tuberculosis. It is usually caused by spread of infection from eustachian tube to middle ear and primary tubercular otitis media is extremely rare. Though the classical features include multiple tympanic membrane perforation, painless otorrhoea and granulation tissue in middle ear cavity it should be suspected in all patients having otitis not responding to usual antibiotics. Our study confirms that there is a definite improvement in hearing following surgical intervention and proper antitubercular therapy.

Keywords: Tuberculous otitis media, granulation tissue, Hearing loss, surgical intervention.