A Case of Tuberculous Otitis Media

Abstract

A 72-year-old man visited our hospital with the complaints of right-sided otorrhea and hearing loss. Otoscopy revealed a large central perforation of the tympanic membrane with granulation tissue at the promontory. A bacterial smear test and culture of his ear discharge were negative for acid-fast bacilli. Histopathological examination of a biopsy specimen obtained from the granulation tissue revealed only necrotic tissue. Thirty-seven days after his first visit, the patient presented with cough and high fever and showed a positive result of the T-SPOT^®.TB blood test for tuberculosis. Based on the observation of a diffuse infiltrative opacities on chest CT and a positive sputum culture test for the Mycobacterium tuberculosis, the patient was diagnosed as having pulmonary tuberculosis. He was also simultaneously diagnosed as having tuberculous otitis media based on a positive result of PCR test of the otorrhea fluid. The patient was started on anti-tuberculosis chemotherapy with isoniazid, rifampicin, ethambutol, and pyrazinamide.

Two years after his first visit to our hospital, we perfomed myringoplasty using a full-thickness tragal cartilage and periosteal pedicle graft to avoid graft necrosis caused by potentially poor wound healing secondary to recurrent tuberculosis. His postoperative course was good and the tympanic membrane showed rapid epithelialization.