Abstract: Tuberculous Otitis Media: Diagnosis and Treatment

Tuberculous Otitis Media: Diagnosis and Treatment Generoso T. Abes, MD, MPH Director, Philippine National Ear Institute Manila, Philippines Objective: To emphasize the importance of early detection and treatment of tuberculous otitis media by providing information on various clinical presentations of the disease, results of diagnostic procedures and clinical and audiologic outcomes after medical and surgical management. Background: Tuberculosis(TB) is a rare cause of chronic suppurative otitis media (<1%). The low prevalence explains the scarcity of knowledge on the clinical presentation of the TB otitis media that usually contributes to late diagnosis. By contrast, the Philippines is ranked number in incidence rate of TB which is one of the top ten causes of mortality in the country. Experiences gathered in areas like the Philippines may provide important information on the clinical course and management of the disease to clinicians practicing in areas where the prevalence of the disease is rare. Study Design: Retrospective case series Setting: Private clinic in a tertiary hospital Materials and Methods: The clinical records of nine patients who were diagnosed with tuberculous otitis media during a five year period (2004-2009) were reviewed. All were healthy looking adults, aged 18-56 years old. Three were men and six were women. All were treated previously as cases of non-tuberculous otitis media prior to diagnosis of TB otitis media. Items in the history that were not included in the clinical records but which were relevant to the diagnosis of TB otitis media were gathered during follow-up visits or through phone interview. Before and after treatment otoscopic pictures, audiograms, CT scan images, and results of other diagnostic tests were retrieved and compared. Results: Four patterns of otoscopic appearances were noted. One patient had perforated tympanic membrane, refractory otorrhea, and exuberant granulation tissue formation; two presented with perforated tympanic membrane, minimal but persistent otorrhea and no or minimal granulation tissue formation; three with intact tympanic membrane with middle ear effusion and another three with intact tympanic membrane with tumor-like tissue in the middle ear cavity. Diagnosis of tuberculosis was confirmed by biopsy in five of eight patients, polymerase chain reaction examination for mycobacterium TB in five of six patients, and TB culture in one of two patients. Examination of the TB bacilli by means of acid fast smear failed in two patients. The notable predictors of TB were poor response to prolonged antibiotic therapy, past history of pulmonary TB, work-related contamination of the infection, positive chest radiograph for TB, positive tuberculin test; and, hearing loss considered disproportionate to the otoscopic picture. Other identified predictors were CT scan images showing soft tissue density occupying the middle ear and mastoid bone with preservation of the mastoid air cell architecture, relative lack of mastoid bone sclerosis, absent erosion of ossicular bone structures and scutum; and, intraoperative finding showing the presence of abundant whitish to yellowish, soft granulation tissues over the middle ear and mastoid cavities. Patients with mild pathology had minimal intervention with resultant good clinical resolution and hearing preservation. Patients with more severe pathology had more extensive intervention, less favorable clinical response and audiometric results. Conclusion: The study demonstrates the importance of integrating clinical and laboratory diagnosis for the early detection of TB otitis media cases that had more favorable results after intervention. Title: Coenzyme Q10 in combination with Steroid therapy for treatment of Sudden Sensorineural Hearing Loss Chan Il Song, MD, Joong Ho Ahn, MD, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Corresponding author: Joong Ho Ahn, MD, PhD Department of Otolaryngology, Asan Medical Center University of Ulsan College of Medicine 388-1 Pungnap-2 dong Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3717 Fax: +82-2-489-2773 E-mail: [email protected]