Nasal or Nasopharyngeal Tuberculosis Should be Considered in the Initial Diagnosis of Sino-Nasal Inflammatory Diseases

Nasal or nasopharyngeal tuberculosis (TB) is rare, and the literature is limited to isolated case reports. The anatomic location is a major field of ear, nose, and throat (ENT) specialists, especially rhinologists. Initial symptoms of nasal and naso-pharyngeal TB are nonspecific, and it is, therefore, a challenge for rhinology specialists to diagnose rhinologic TB earlier. We reviewed medical records, images, and histological results between 1998 and 2014 and have found that 4 nasal TB and 8 na-sopharyngeal TB patients were diagnosed and managed in Severance Hospital (Table 1). The mean age of the patients with nasal TB was 52.5 years. Most of the patients with nasal TB were middle-aged and female , similar to those in a previous report. 1 Bilateral involvement or the spread of TB into adjacent structures can occur in nasal TB because of the anatomic structure of the nasal cavity. 2 In our cases, however, only 1 TB that originated in the sep-tum spread bilaterally in the nasal cavity, making septal perforation ; the other infections were localized to the primary infection site. It has been reported that the recurrence rate of nasal TB after surgical excision is greater than 50%, 3 and the recommended medical treatment for nasal TB is the same as that for other category III TB lesions. 2 All of our patients with nasal TB received medical treatment for 6 to 12 months, and there was no recurrence or regrowth during the average 7 year follow up. Based on previous reports, nasopharyngeal TB is slightly more common among females, 4 and 7 out of the 8 patients with nasopharyngeal TB in our review were female. The mean age of the patients with nasopharyngeal TB was 34 years, and half of all the patients were in their twenties, making our patients younger overall compared with those in previous case reports. 5 The most common symptom of nasopharyngeal TB in our study was otologic discomforts such as ear fullness or hearing impairment, although upper cervical lymphadenopa-thy was the most common clinical presentation of nasopha-ryngeal TB in a previous study. 5 Three patients in our study received treatment for ear symptoms such as myringotomy before being diagnosed with TB, which delayed the early diagnosis. Therefore, our results show that consideration of the possibility of nasopharyngeal TB in patients with otologic manifestations who were not responsive to conventional management is really important. Nasal or nasopharyngeal TB …