European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 7, pp 2083–2089 | Cite as

Primary tuberculosis of the middle ear cleft: diagnostic and therapeutic considerations

  • Balázs Liktor
  • Bálint Liktor
  • Bálint LiktorJr.
  • Judit Kálmán
  • Barnabás Horváth
  • István Sziklai
  • Tamás KarosiEmail author
Case Report


Tuberculosis remains one of the most challenging infectious diseases, which rarely manifests in the middle ear cleft exclusively. Typical symptoms of tuberculosis have become more and more confusing due to the genetic evolution of different Mycobacterium species. In the diagnosis of tuberculous otitis media (TOM), clinical suspicion plays a fundamental role, when topical and/or systemic antibiotic treatment cannot lead to improvement in ear discharge and inflammation. If there is no other reason of persisting otorrhea, microbiological sampling and culturing are the subsequent steps of diagnosis. These investigations, however, have low sensitivity; therefore a canal wall-up mastoidectomy is recommended, which includes the removal of necrotic bone and multiple histological sampling from various locations. Currently, histopathological analysis is the most robust and reliable method in the diagnosis of TOM. Tuberculin skin test, Mycobacterium-specific PCR and interferon-gamma release assay cannot distinguish between active, inactive or post-infective conditions. According to these considerations, these methods may serve as supplementary assays for the final diagnosis. Having the appropriate diagnosis after surgical intervention and laboratory analysis, medical management should be continued by anti-tuberculosis chemotherapy. Hereby, we demonstrate two cases with primary TOM and provide an overview of the literature in the light of diagnostic and therapeutic guidelines in the management of TOM.


Mastoidectomy Middle ear cleft Otitis media Tuberculosis 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Nalini B, Vinayak S (2006) Tuberculosis in ear, nose and throat practice: its presentation and diagnosis. Am J Otolaryngol 27(1):39–45PubMedCrossRefGoogle Scholar
  2. 2.
    Ahmad S (2011) Pathogenesis, immunology and diagnosis of latent Mycobacterium tuberculosis infection. Clin Dev Immunol 2011:814943PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    WHO Global tuberculosis report (2012). WHO/HTM/TB/2012.6Google Scholar
  4. 4.
    Chmielik LP, Ziolkowski J, Koziolek R, Kulus M, Chmielik M (2008) Ear tuberculosis: clinical and surgical treatment. Int J Ped Otorhinolaryngol 72:271–274CrossRefGoogle Scholar
  5. 5.
    Sia IG, Wieland ML (2011) Current concepts in the management of tuberculosis. Mayo Clin Proc 86(4):348–361PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Lalic H, Kukuljan M, Pavicic MD (2010) A case report of occupational middle ear tuberculosis in a nurse. Arh Hig Rada Toksikol 61(3):333–337PubMedCrossRefGoogle Scholar
  7. 7.
    Odetoyinbo O (1988) Early diagnosis of tuberculous otitis media. J Laryngol Otol 102(2):133–135PubMedCrossRefGoogle Scholar
  8. 8.
    Awan MS, Salahuddin I (2002) Tuberculous otitis media: two case reports and a literature review. Ear Nose Throat J 81(11):792–794PubMedGoogle Scholar
  9. 9.
    Kim CW, Jin JW, Rho YS (2007) Tuberculous otitis media developing as a complication of tympanostomy tube insertion. Eur Arch Otorhinolaryngol 264:227–230PubMedCrossRefGoogle Scholar
  10. 10.
    Dale OT, Clarke AR, Drysdale AJ (2011) Challenges encountered in the diagnosis of tuberculous otitis media: case report and literature review. J Laryngol Otol 125(7):738–740PubMedCrossRefGoogle Scholar
  11. 11.
    Cho YS, Lee HS, Kim SW, Chung KH, Lee DK, Koh WJ, Kim MG (2006) Tuberculous otitis media: a clinical and radiological analysis of 52 patients. Laryngoscope 116:921–927PubMedCrossRefGoogle Scholar
  12. 12.
    Cole ST, Brosch R, Parkhill J, Garnier T, Churcher C, Harris D, Gordon SV, Eiglmeier K, Gas S, Barry CE 3rd, Tekaia F, Badcock K, Basham D, Brown D, Chillingworth T, Connor R, Davies R, Devlin K, Feltwell T, Gentles S, Hamlin N, Holroyd S, Hornsby T, Jagels K, Krogh A, McLean J, Moule S, Murphy L, Oliver K, Osborne J, Quail MA, Rajandream MA, Rogers J, Rutter S, Seeger K, Skelton J, Squares R, Squares S, Sulston JE, Taylor K, Whitehead S, Barrell BG (1998) Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence. Nature 393(6685):537–544PubMedCrossRefGoogle Scholar
  13. 13.
    Szoby Z, Sziklai I, Méhes G, Kónya J, Benkő K (2012) Primer középfül tuberkulózis. Otorhinolaryngol Hung 58(3):9–12Google Scholar
  14. 14.
    Sens PM, Almeida CIR, Valle LO, Costa LHC, Angeli MLS (2008) Tuberculosis of the ear, a professional disease? Bras J Otorrinolaringol 74(4):621–627CrossRefGoogle Scholar
  15. 15.
    Tang IP, Prepageran N, Ong CA, Puraviappan P (2010) Diagnostic challenges in tuberculous otitis media. J Laryngol Otol 124:913–915PubMedCrossRefGoogle Scholar
  16. 16.
    Wallner LJ (1953) Tuberculous otitis media. Laryngoscope 63(11):1058–1077PubMedCrossRefGoogle Scholar
  17. 17.
    Windle-Taylor PC, Bailey CM (1980) Tuberculous otitis media: series of 22 patients. Laryngoscope 90(6 Pt 1):1039–1044PubMedGoogle Scholar
  18. 18.
    Aremu SK, Alabi BS (2010) Tuberculous otitis media: a case presentation and review of the literature. BMJ Case Rep. doi: 10.1136/bcr.02.2010.2721 PubMedCentralPubMedGoogle Scholar
  19. 19.
    Shingadia D (2012) The diagnosis of tuberculosis. Pediatr Infect Dis J 31(3):302–305PubMedCrossRefGoogle Scholar
  20. 20.
    Hoshino T, Miyashita H, Asai Y (1994) Computed tomography of the temporal bone in tuberculous otitis media. J Laryngol Otol 108:702–705PubMedCrossRefGoogle Scholar
  21. 21.
    Migliori GB, Zellweger JP, Abubakar I, Ibraim E, Caminero JA, DeVries G, D’Ambrosio L, Centis R, Sotgiu G, Menegale O, Kliiman K, Aksamit T, Cirillo DM, Danilovits M, Dara M, Dheda K, Dinh-Xuan AT, Kluge H, Lange C, Leimane V, Loddenkemper R, Nicod LP, Raviglione MC, Spanevello A, Thomsen VO, Villar M, Wanlin M, Wedzicha JA, Zumla A, Blasi F, Huitric E, Sandgren A, Manissero D (2012) European Union standards for tuberculosis care. Eur Respir J 39:807–819PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Balázs Liktor
    • 1
  • Bálint Liktor
    • 2
  • Bálint LiktorJr.
    • 3
  • Judit Kálmán
    • 2
  • Barnabás Horváth
    • 2
  • István Sziklai
    • 4
  • Tamás Karosi
    • 1
    Email author
  1. 1.Department of Otolaryngology, Head and Neck SurgeryB-A-Z County Hospital and University HospitalMiskolcHungary
  2. 2.Department of OtolaryngologyBajcsy-Zsilinszky HospitalBudapestHungary
  3. 3.Department of OtolaryngologyGeneral Hospital OberwartOberwartAustria
  4. 4.Medical and Health Science Center, Department of Otolaryngology, Head and Neck SurgeryUniversity of DebrecenDebrecenHungary

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