title: Subacute tuberculous otitis media complicated by petrositis and meningitis.
abstract: OBJECTIVE
  The aim of our case study is to illustrate diagnostic and therapeutic difficulties as well as gravity related to tuberculous otitis media with intracranial complications.
  
  
  METHODS
  A diabetic male patient of 65 years old was treated for subacute otitis media with mixed hearing loss. Early bacteriologic samples from ear exudates revealed opportunistic pathogens. Clinical evolution after four months was marked by the appearance of mastoiditis with facial paralysis. The patient presented petrositis and bilateral laryngeal paralysis with lymphocytic meningitis after six and eight months respectively. Tuberculosis was suspected after a positive ELlspot tests with appearance of biologic markers of hepatic dysfunction like cholestasis and hepatic cytolysis. Although antituberculous treatment was instaured even without isolation of acid fast bacilli, the patient died after ten months.
  
  
  CONCLUSIONS
  Subacute otitis media complicated by labyrinthitis, early onset of facial paralysis or any other oranial nerve palsy should raise suspicion of tuberculosis. The prognosis depends on early diagnosis which remains difficult despite morphological and metabolic imaging. The diagnostic workup should include histological and bacteriologic samples, liver markers of intacellular damage as well as ELlspot test. The prognosis remains poor especially in immunocompromised patients despite appropriate treatment.
authors.affiliation: CHU de Grenoble, Clinique Universitaire d'ORL, Pô1e TCCR, I avenue des Maquis du Grésivaudan, 38043 Grenoble cedex 09, France.
authors.forename: G
authors.initials: G
authors.lastname: Dumas
authors.forename: S
authors.initials: S
authors.lastname: Schmerber
authors.forename: I
authors.initials: I
authors.lastname: Atallah
authors.forename: J-P
authors.initials: JP
authors.lastname: Brion
authors.forename: C A
authors.initials: CA
authors.lastname: Righini
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D059270:Petrositis / Q000188:drug therapy / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents