Tubercular otitis media: an under diagnosed entity

Abhishek Maheshwari, Rajlaxmi Panigrahi


Background: Tubercular otitis media (TOM) is a well described rare entity in literature. Its characteristic diagnostic delay leads to severe irreversible complications. Diagnosis is much more difficult when it co-exists with aural cholesteatoma. Its Actual incidence is thought to be much more, than what is reported in literature. This study was carried out to establish TOM as an under diagnosed entity and to study its various presentations.

Methods: A prospective study was performed in 617 cases (both recurrence and new) of chronic otitis media who gave a fully informed consent, for being investigated for a probable diagnosis of TOM, based on history and clinical findings. Histopathological examination of the granulation tissue retrieved during biopsy/mastoid exploration surgery and mycobacterial culture of the aural discharge was performed in all cases. A final diagnosis was made with either of tests being reported as positive for mycobacterium tuberculosis infection. All confirmed cases were treated with a 6 month course of anti-tubercular therapy.  

Results: Diagnosis of TOM was confirmed in 12 cases. M:F ratio was 1:1.4. Cholesteatoma was found to co-exist in 4 cases (33.33%). A positive histopathology report was obtained in 11 cases (91.67%) while the mycobacterial culture yielded growth in 3 cases (25%) only. Canal wall down mastoidectomy was performed in 9 cases. In all cases, a follow-up with a 6 months course of anti-tubercular therapy gave satisfactory healing with no complications.

Conclusions: The incidence of TOM, a potentially dangerous entity is on a rise. Role of surgery is crucial in procuring tissue for histopathological and bacteriological examination.  It is a curable disease if diagnosed in time with early institution of anti-tubercular therapy.


Tubercular otitis media, Granulation, Facial paralysis, Anti-tubercular therapy

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