Case Report: Middle ear tuberculosis - a rare but serious differential diagnosis of otitis media

Introduction Worldwide each year around 10 million people fall ill with tuberculosis (TBC). Because of migration 2015 there was an increased incidence in germany. In 80 %  the lungs are affected, but in pinciple each organ can be affected. Only 0,04 %  of the cases of chronic otitis media are caused by mycobacterium tuberculosis. That’s a rare differential diagnosis.

Case report: A 80 year-old man presented with reccurent, painless otorrhea and hearing loss in the left ear. The CT scan oft he temporal bone demonstrated mastoid cell obliteration with bone erosion of the middle cranial fossa. The intraoperativ findings revealed whitish granulation tissue masses, which destroyed the ossicles, the facial canal und the bone of the middle cranial fossa. The histopathological and PCR examination showed tuberculosis. A pulmonary tuberculosis was excluded (CT scan of the lungs, bronchoscopy, sputum examination). A combined anti-tuberculosis therapy was started (rifampin, isoniazid, ethambutol, pyrazinamide) and a second-look operation is planned after the end of therapy (9-12 months).

Conclusion The clinical signs of the tuberculosis of the middle ear do not have many differences to a purulent middle ear infection an should not be forgotten as a differential diagnosis. Typical ist a long-lasting, painless otorrhoea with multiple perforations of the tympanic membrane and pale granulation tissue in the middle ear. The first line therapy is the medical treatment, while surgery is necessary in case of complications or in order to reconstruct.

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Publication History

Article published online:
13 May 2021