1887

Abstract

Tuberculosis (TB) of the head and neck can be contained in the lymph nodes, larynx, oropharynx, salivary glands, nose and paranasal sinuses, ear, skin and skull. Head and neck TB presentations are varied in nature and thus difficult to diagnose. The clinical features, radiological findings, microbiological diagnostic modalities, surgical and medical management and outcomes of nine cases of head and neck TB are discussed in detail here, together with a thorough review of the literature. Patients presented with atypical symptoms such as discharging sinus, ear lobule swelling, otitis media, vision loss and facial weakness, long refractory otorrhoea and granulation tissue in the ear canal. We diagnosed tubercular skull base osteomyelitis (one case) and laryngeal tuberculosis (two cases), mastoid tuberculosis (one case) and non-tubercular mycobacterial infection involving the temporal bone (two cases), sino-nasal region (one case), maxilla (one cases) and ear lobule (one case) over a period of 8 months. All patients were managed successfully with a combination of surgery and a well-planned treatment regimen for non-tuberculous mycobacteria (NTM) or anti-tubercular drugs for TB. All had successful outcomes except one patient with tubercular skull base osteomyelitis who expired before the initiation of anti-tubercular therapy (ATT). High clinical suspicion followed by thorough diagnostic work-up for both TB and NTM would enable early diagnosis and complete treatment.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The Microbiology Society waived the open access fees for this article.
Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000304
2021-12-17
2022-01-27
Loading full text...

Full text loading...

/deliver/fulltext/acmi/3/12/acmi000304.html?itemId=/content/journal/acmi/10.1099/acmi.0.000304&mimeType=html&fmt=ahah

References

  1. World Health Organization Global tuberculosis report; 2020 https://www.who.int/publications/i/item/9789240013131
  2. Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. American J Otolaryngology 2006; 27:39–45 [View Article]
    [Google Scholar]
  3. Lmekki S, Lecanu JB. Tuberculosis of the middle ear and nasal passage: A case report. Inter J Mycobact 2013; 2:51–53 [View Article]
    [Google Scholar]
  4. Cho Y-S, Lee H-S, Kim S-W, Chung K-H, Lee D-K et al. Tuberculous otitis media: a clinical and radiologic analysis of 52 patients. Laryngoscope 2006; 116:921–927 [View Article] [PubMed]
    [Google Scholar]
  5. Linmans JJ, Stokroos RJ, Linssen CFM. Mycobacterium abscessus, an uncommon cause of chronic otitis media: a case report and literature review. Arch Otolaryngol Head Neck Surg 2008; 134:1004–1006 [View Article] [PubMed]
    [Google Scholar]
  6. Mohamad Yusof AN, Mohamad I, Haron A, Salahuddin Z. Unusual presentations of tuberculosis – A case series. Egyptian J Ear, Nose, Throat and Allied Sciences 2016; 17:155–158 [View Article]
    [Google Scholar]
  7. Basal Y, Ermişler B, Eryilmaz A, Ertuğrul B. Two rare cases of head and neck tuberculosis. BMJ Case Rep 2015; 2015:bcr2015211897 [View Article] [PubMed]
    [Google Scholar]
  8. Halim MS, Ahmed SQ, Junaid M, Bashir MR. Tuberculosis verrucosa cutis in a patient with keloid over ear lobule. BMJ Case Rep 2013; 2013:bcr2013010294 [View Article] [PubMed]
    [Google Scholar]
  9. Felemban T, Ashi A, Sindi A, Rajab M, Jehani ZA. Hoarseness of voice as a rare presentation of tuberculosis: a case report study. Open Access Maced J Med Sci 2019; 7:3262–3264 [View Article] [PubMed]
    [Google Scholar]
  10. Matimba A, Moncho M, Musoke J, Seedat RY. Diagnosis of laryngeal tuberculosis in a high TB burden area. Eur Arch Otorhinolaryngol 2020; 277:2137–2140 [View Article] [PubMed]
    [Google Scholar]
  11. Nawas MT, Daruwalla VJ, Spirer D, Micco AG. Nemeth complicated necrotizing otitis externa. American J Otolaryngology—Head and Neck Medicine and Surgery 2013; 34:706–709
    [Google Scholar]
  12. Carfrae MJ, Kesser BW. Malignant otitis externa, Otolaryngologic. Clinics of North America 2008; 41:537–549
    [Google Scholar]
  13. Sreepada GS, Kwartler JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 2003; 11:316–323 [View Article] [PubMed]
    [Google Scholar]
  14. Kornilenko L, Arechvo I. Aggressive bilateral temporal bone tuberculosis. a case report. Theory and Practice in Medicine 2016; 22:437–440
    [Google Scholar]
  15. Illing E, Zolotar M, Ross E, Olaleye O, Molony N. Malignant otitis externa with skull base osteomyelitis. J Surg Case Rep 2011; 2011:6 [View Article]
    [Google Scholar]
  16. Patmore H, Jebreel A, Uppal S. McWhinney,“Skull base infection presenting with multiple lower cranial nerve palsies. American Journal of Otolaryngology—Head and Neck Medicine and Surgery 2010; 31:376–380
    [Google Scholar]
  17. Rubin Grandis J, Branstetter BF 4th, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004; 4:34–39 [View Article] [PubMed]
    [Google Scholar]
  18. Mani N, Sudhoff H, Rajagopal S, Moffat D, Axon PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007; 117:907–910 [View Article] [PubMed]
    [Google Scholar]
  19. Castro R, Robinson N, Klein J, Geimeier W. Malignant external otitis and mastoiditis associated with an IgG4 subclass deficiency in a child. Del Med J 1990; 62:1417–1421 [PubMed]
    [Google Scholar]
  20. Cassidy PM, Hedberg K, Saulson A, McNelly E, Winthrop KL. Nontuberculous mycobacterial disease prevalence and risk factors: a changing epidemiology. Clin Infect Dis 2009; 49:e124–9 [View Article] [PubMed]
    [Google Scholar]
  21. Yeh CF, Yang Tu T, Wang MC, Chu CH, Huang CY. Emergence of refractory otomastoiditis due to nontuberculous mycobacteria. Clin Infect Dis 2016; 62:739–745
    [Google Scholar]
  22. KC W, Shu MT, Chen BN. Otomastoiditis with acute left facial nerve paralysis caused by mycobacterium chelonae. Ear Nose Throat J 2011; 90:e18–22
    [Google Scholar]
  23. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367–416 [View Article] [PubMed]
    [Google Scholar]
  24. Chen P-Y, Wu C-C, Yang T-L, Hsu C-J, Lin Y-T et al. Gradenigo syndrome caused by nontuberculous mycobacteria. Audiol Neurootol 2014; 19:275–282 [View Article] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/acmi/10.1099/acmi.0.000304
Loading
/content/journal/acmi/10.1099/acmi.0.000304
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error