title: The variable clinical presentation of tuberculosis otitis media and the importance of early detection.
abstract: BACKGROUND
  Tuberculosis (TB) is a rare cause of otitis media. This study aims to increase awareness on the clinical presentation of TB otitis media and illustrate how early detection affects treatment outcome.
  
  
  METHODS
  Chart review of 12 patients (13 ears) from a tertiary hospital in Manila, Philippines, seen from 2004 to 2009. Clinical predictors of the disease were summarized. Clinical, radiologic, and audiometric outcomes after treatment were compared between treatment groups.
  
  
  RESULTS
  The 5 otoscopic presentations were multiple perforations, single perforation with refractory otorrhea and exuberant granulation tissue formation, single perforation with minimal otorrhea and no granulation tissue formation, intact tympanic membrane with middle ear effusion, and intact tympanic membrane with tumorlike tissue in the middle ear. Clinical predictors of the disease were history of pulmonary TB, work-related contamination of the infection, positive purified protein derivative test, positive chest radiographic finding and intraoperative granulation tissue with cheesy material, and temporal bone computed tomographic scan findings. Patients who had no middle ear surgery showed significantly better clinical, radiologic, and audiometric outcomes than those who were diagnosed late and had more complicated surgical procedure.
  
  
  CONCLUSIONS
  The clinical presentation of TB otitis media is variable. Early detection of the early forms entail less surgical intervention and favors better treatment results.
authors.affiliation: Philippine National Ear Institute, National Institutes of Health, Manila, Philippines. abesgt@yahoo.com
authors.forename: Generoso T
authors.initials: GT
authors.lastname: Abes
authors.forename: Franco Louie L B
authors.initials: FL
authors.lastname: Abes
authors.forename: Joselito C
authors.initials: JC
authors.lastname: Jamir
mesh_terms: D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D042241:Early Diagnosis; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010035:Otitis Media, Suppurative / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin