A Case of Tuberculous Otitis Media

Abstract

We report a case of tuberculous otitis media. This disease is very rare and hence not easily diagnosed by most otolaryngologists in Japan. An 86-year-old man with hearing loss and ear discharge was referred to Kariya Toyota General Hospital. Initially, he was diagnosed as having acute otitis media at a local clinic, and treated with antibiotics and myringotomy, but his symptoms failed to improve. At his first visit to our hospital, we diagnosed him as having otitis media with effusion and inserted a tympanostomy tube. However, 32 days later, his ear discharge persisted. We then suspected intractable otitis media and conducted tests to rule out tuberculous otitis media and anti-neutrophil cytoplasmic antibody (ANCA)-associated disease; the results led to the diagnosis of tuberculous otitis media. The interval from a patient’s first visit to a medical institution to diagnosis of the disease is called “Doctor’s delay.” On the other hand, the interval between the onset of symptoms and the patient’s first visit to a medical institution is called “Patient’s delay.” In this case, the Doctor’s delay was 11 weeks, while the Patient’s delay was only a few days. It is often difficult to diagnose tuberculous otitis media in the absence of typical physical findings. A delay in diagnosis may lead to the development of pulmonary tuberculosis, since patients with tuberculous otitis media also often suffer from pulmonary tuberculosis. Hence, in patients presenting with intractable otitis media, examinations such as smear and culture examinations and polymerase chain reaction assay of ear discharge fluid and biopsy of granulation tissue should be conducted to rule out tuberculosis otitis media.