Otolaryngological Manifestations of Tuberculosis: A Clinical Study

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The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties. A prospective study of patients who presented to us, at a tertiary referral hospital, primarily with TB of head and neck was done from September 2014 to August 2016. Patients were categarised into proper category of Anti Tuberculous Treatment (ATT) and were treated according to ATT regimen. All patients were followed up at 2 months and 6 months after starting ATT. A total of 170 patients presented with primary head and neck TB during the study period. Most of these (96%) had cervical lymphadenopathy, 5 patients had laryngeal TB, and there was 1 patient each of TB of middle ear. 102 were males, and 68 were females. 25.8% of cases had associated pulmonary TB. (1) Diagnosing TB requires a high index of suspicion. (2) Tuberculosis of the cervical lymph nodes is the commonest presentation followed by laryngeal TB. (3) Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, newer diagnostic tests will increase the yield of positive cases and should be used whenever required. (4) In the larynx, the vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. (5) Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB.

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  1. 1.

    Ryan KJ, Ray CG (eds) (2004) Sherris medical microbiology, 4th edn. McGraw Hill, New York. ISBN 0-8385-8529-9

  2. 2.

    Manolidis S, Frenkiel S, Yoskovitch A, Black M (1993) Mycobacterial infections of the head and neck. Otolaryngol Head Neck Surg 109:427–433

  3. 3.

    Soni NK, Chatterjee P (1978) Laryngeal tuberculosis. Indian J Otolaryngol 30:115–117

  4. 4.

    Travis LW, Hybels RL, Newman MH (1976) Tuberculosis of the larynx. Laryngoscope 86:549–558

  5. 5.

    Lucente FE, Tobias GW, Parisier SC, Som PM (1978) Tuberculous otitis media. Laryngoscope 88:1107–1116

  6. 6.

    Hoshino T, Miyashita H, Asai Y (1994) Computed tomography of the temporal bone in tuberculous otitis media. J Laryngol Otol 108:702–705

  7. 7.

    Ng PC, Hiu J, Fok TF, Nelson EA, Cheung KL, Wong W (1995) Isolated congenital tuberculosis otitis in a preterm infant. Acta Paediatr 84:955–956

  8. 8.

    Soni NK, Chatterji P, Chhimpa I (1979) Lingual tuberculosis. Indian J Otolaryngol 31:92-2

  9. 9.

    Komet H, Schaefer RF, Mahoney PL, Antonio S (1965) Bilateral tuberculosis granulomas of the tongue. Arch Otolaryngol 82:649–651

  10. 10.

    Fanning A (1999) Tuberculosis: 6. Extrapulmonary disease. CMAJ 160:1597–1603

  11. 11.

    Report from the Medical Research Council Tuberculosis and Chest Diseases Unit. (1987) National survey of tuberculosis notifications in England and Wales in 1983: characteristics of disease. Tubercle 68:19–32

  12. 12.

    Medical Research Council Cardiothoracic Epidemiology Group (1992) National survey of notifications of tuberculosis in England and Wales in 1988. Thorax 47:770–775

  13. 13.

    Weir MR, Thornton GF (1985) Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature. Am J Med 79:467–478

  14. 14.

    Pitchenik AE, Fertel D, Bloch AB (1988) Mycobacterial disease: epidemiology, diagnosis, treatment, and prevention. Clin Chest Med 9:425–441

  15. 15.

    Snider DE Jr, Roper WL (1992) The new tuberculosis. N Engl J Med 326:703–705

  16. 16.

    Snider DE, Onorato M (1995) Epidemiology. In: Rossman MD, MacGregor RR (eds) Tuberculosis: clinical management and new challenges. McGraw-Hill, New York, pp 3–17

  17. 17.

    Reported tuberculosis in the United States 1999. Centers for Disease Control and Prevention, Atlanta, Aug 2000

  18. 18.

    American Thoracic Society (2000) Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 161:1376–1395

  19. 19.

    Mohan A, Sharma SK (2001) Epidemiology. In: Sharma SK, Mohan A (eds) Tuberculosis. Jaypee Brothers Medical Publishers, New Delhi, pp 14–29

  20. 20.

    Raviglione MC, Narain JP, Kochi A (1992) HIV-associated tuberculosis in developing countries: clinical features, diagnosis and treatment. Bull World Health Organ 70:515–525

  21. 21.

    Theuer CP, Hopewell PC, Elias D, Schecter GF, Rutherford GW, Chaisson RE (1990) Human immunodeficiency virus infection in tuberculosis patients. J Infect Dis 162:8–12

  22. 22.

    Haas DW, Des Prez RM (1994) Tuberc ulosis a nd acquired immunodeficiency syndrome: a historical perspective on recent developments. Am J Med 96:439–450

  23. 23.

    Shafer RW, Kim DS, Weiss JP, Quale JM (1991) Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine (Baltimore) 70:384–397

  24. 24.

    Antonucci G, Girardi E, Armignacco O, Salmaso S, Ippolito G (1992) Tuberculosis in HIV-infected subjects in Italy: a multicentre study. The Gruppo Italiano di Studio Tubercolosi e AIDS. AIDS 6:1007–1013

  25. 25.

    Jones BE, Young SMM, Antoniskis D, Davidson PT, Kramer F, Barnes PF (1993) Relations hip of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis 148:1292–1297

  26. 26.

    Lado Lado FL, Barrio Gomez E, Carballo Arceo E, Ortiz Cabarcos, de Barron A (1999) Clinical presentation of tuberculosis and the degree of immunodeficiency in patients with HIV infection. Scand J Infect Dis 31:387–391

  27. 27.

    Lee MP, Chan JW, Ng KK, Li PC (2000) Clinical manifestations of tuberculosis in HIV-infected patients. Respirology 5:423–426

  28. 28.

    Poprawski D, Pitisuttitum P, Tansuphasawadikul S (2000) Clinical presentations and outcomes of TB among HIV-positive patie NTS. Southeast Asian J Trop Med Public Health 31(Suppl 1):140–142

  29. 29.

    Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H (2010) Mycobacterial outer membranes: in search of proteins. Trends Microbiol 18(3):109–116.

  30. 30.

    Iscman MD (2000) Tuberculosis in relation to human immunodeficiency virus and acquired immunodeficiency syndrome. In: Iseman MD (ed) A clinician‘s guide to tuberculosis. Lippincott Williams and Wilkins, Philadelphia, pp 199–252

  31. 31.

    Dutt AK, Stead WW (1999) Epidemiology. In: Schlossberg D (ed) Tuberculois and nontuberculous mycobacterial infection. W.B. Saunders Company, Philadelphia, pp 3–16

  32. 32.

    Dandapat MC, Mishra BM, Dash SP, Kar PK (1990) Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg 77:911–912

  33. 33.

    Subrahmanyam M (1993) Role of surgery and chemotherapy for peripheral lymph node tuberculosis. Br J Surg 8:1547–1548

  34. 34.

    Jawahar MS, Sivasubramaniam S, Vijayan VK, Ramakrishnan CV, Paramasivan CN, Selvakumar V et al (1990) Short-course chemotherapy for tuberculous lymphadenitis in children. BMJ 301:359–362

  35. 35.

    Kukreja HK, Sacha BS, Joshi KC (1977) Tuberculosis of maxillary sinus. Indian J Otolaryngol 29:27–28

  36. 36.

    Krishnan E, Rudraksha MR (1978) Paranasal sinus tuberculosis. India J Otolaryngol 30:125–126

  37. 37.

    Bahadur S, Thakar A (2008) Specific chronic infections. Scott- Brown's Otorhinolaryngology, Head and Neck surgery. 7th edn, vol 2, pp 1458–1459

  38. 38.

    Chen YM, Lee PY, Su WJ, Perng RP (1992) Lymph node tuberculosis: 7-year experience in Veterans General Hospital, Taipei, Taiwan. Tuber Lung Dis 73:368–371

  39. 39.

    Fain O, Lortholary O, Djouab M, Amoura I, Bainet P, Beaudreuil J et al (1999) Lymph node tuberculosis in the suburbs of Paris: 59 cases in adults not infected by the human immunodeficiency virus. Int J Tuberc Lung Dis 3:162–165

  40. 40.

    Akkara et al (2014) A study of manifestations of extrapulmonary tuberculosis in the ENT region. Indian J Otolaryngol Head Neck Surg 66(1):46–50

  41. 41.

    Thompson MM, Underwood MJ, Sayers RD, Dookeran KA, Bell PRF (1992) Peripheral tuberculous lymphadenopathy: a review of 67 cases. Br J Surg 79:763–764

  42. 42.

    Nalini B et al (2006) Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol Head Neck Med Surg 27(1):39–45

  43. 43.

    Das S, Das D, Bhuyan UT, Saikia N (2016) Head and neck tuberculosis: scenario in a tertiary care hospital of North Eastern India. J Clin Diagn Res 10(1):MC04-7

  44. 44.

    Khan KA, Khan NA, Maqbool M (2002) Otorhinolaryngological manifestation of tuberculosis. JK Sci 4(3):115–118

  45. 45.

    Kamal MS et al (2016) Cervical tuberculous lymphadenitis: clinico-demographic profiles of patients in a secondary level hospital of Bangladesh. Pak J Med Sci 32(3):608–612

  46. 46.

    Yencha MW et al (2000) Am J Otolaryngol 21(2):122–126

  47. 47.

    Rupa V, Bhanu TS (1989) Laryngeal tuberculosis in the eighties—an Indian experience. J Laryngol Otol 103:864–868

  48. 48.

    Thaller SR, Gross JR, Pilch BZ, Goodman M (1987) Laryngeal tuberculosis as manifested in the decades 1963–1983. Laryngoscope 97:848–850

  49. 49.

    Bailey CM, Taylor Windle PC (1981) Tuberculous laryngitis, a series of 37 patients. Laryngoscope 91:93–100

  50. 50.

    Soda A, Haracio Rubio, Salezar Jose G (1989) Tuberculosis of Larynx: clinical aspect in 19 patients. Laryngoscope 99(11):1147

  51. 51.

    Soni NK, Chatterjee P (1978) Laryngeal tuberculosis. Ind J Otol 30:115

  52. 52.

    Singh IKK, Kakar PK, Lahiri AK (1971) Ind J Otolaryngol 23:78

  53. 53.

    Sousa RT, Briglia MFS, Lima LCN, Carvalho RS, Teixeira LM et al (2010) Frequency of otorhinolaryngologies manifestations in patients with pulmonary TB. Int Arch Otorhinolaryngol 14(2):156–162

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Correspondence to Kaustubh Mehta.

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Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Ethics Committee, Department of Pharmacology, Government Medical College, Nagpur (Registration No. ECR/43/Inst/M1I/2013/RR-19).

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Written Informed Consent was taken from all 170 patients involved in the study.

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Bokare, B., Mehta, K. Otolaryngological Manifestations of Tuberculosis: A Clinical Study. Indian J Otolaryngol Head Neck Surg (2020) doi:10.1007/s12070-020-01789-x

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  • Tuberculosis
  • Pulmonary
  • FNAC
  • Lymph node
  • Anti tuberculous treatment