title: Middle ear tuberculosis: diagnostic criteria.
abstract: BACKGROUND
  Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease.
  
  
  OBJECTIVE
  Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis.
  
  
  METHODS
  Medical records of 12 patients with tuberculous otitis and 163 patients with cholesteatoma treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery in Belgrade during the eight-year period were analyzed. All of the patients underwent otomicroscopic, audiological and radiological examination of the thorax and temporal bone, microbiological examination of the secretion and histomorphological examination of the tissue taken during middle ear surgery. Statistical analysis was done using chi2 test with Yates correction.
  
  
  RESULTS
  Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. Coexistence with miliary pulmonary tuberculosis was detected in one third of the patients. There were no microbiological or histomorphological confirmations of the disease, except in one case with positive ZiehI-Neelsen staining.
  
  
  CONCLUSIONS
  Tuberculous otitis media should be considered in patients with serious otogenic complications and with shorter duration of ear discharge, and in association with diagnosed miliary pulmonary tuberculosis and extensive temporal bone destruction. Polymerase chain reaction still is not reliable for diagnosis.
authors.affiliation: Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia. xeniam@sezampro.rs
authors.forename: Snezana
authors.initials: S
authors.lastname: Jesić
authors.forename: Svetlana
authors.initials: S
authors.lastname: Stosić
authors.forename: Branislava
authors.initials: B
authors.lastname: Milenković
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nesić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dudvarski
authors.forename: Ana
authors.initials: A
authors.lastname: Jotić
authors.forename: Nikola
authors.initials: N
authors.lastname: Slijepcević
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005158:Facial Paralysis / Q000209:etiology; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology; D013701:Temporal Bone / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging