We report a rare case of tuberculous otitis media that was difficult to diagnose. The patient was a 24-year-old Chinese woman working at a factory in Japan. Her chief complaint was left hearing loss and otorrhea. She had no family or past history of tuberculosis (TB) infection. She became aware of the hearing loss about three months previous, and was diagnosed with left acute otitis media at a nearby ENT clinic the following month. After tympanostomy, her condition temporarily improved. However, the symptoms gradually worsened and she was admitted to the ENT department of the General Hospital. She received antibiotic treatment (FMOX · GRNX) and was put on a steroid tapering schedule. She was referred to our hospital because of recurrence of otorrhea about 2 weeks later. On admission, the perforation of the tympanic membrane was located in the anterior quadrant, and ear discharge was transparent. The bacteriological examination, acid-fast stain test, and TB-PCR for otorrhea were negative. The chest X-p was normal, and a temporal bone CT scan revealed fluid density in her middle ear and mastoid. Her laboratory findings were normal. She was treated with antibiotic medication (ABPC / SBT) and ear irrigation. The otorrhea subsided in 2 weeks. After 12 days from discharge, we received a report that M. tuberculosis was detected in the culture results of the ear discharge on admission.
Tuberculous otitis media is difficult to diagnose in the early stages, and TB may not be detected by the PCR method if there is a small amount of M. tuberculosis. Moreover, the use of fluoroquinolones delays the diagnosis of TB. However, fluoroquinolones are used frequently in the treatment of otitis media. When we encounter refractory otitis media in everyday practice, we should keep in mind the possibility of tuberculous otitis media.
