OTIC Tuberculosis (TB)

Timothy C. Hain, MD Return to Index. • Page last modified: August 27, 2022

Main Points:

Tuberculosis is presently a rare cause of ear infection in the United States. In the US, it is mainly managed by checking for positive TB skin tests, and then treating positive individuals. In other countries such as China, it is managed with vaccinations with BCG. Tuberculosis is much more common in immunocompromised individuals such as those with HIV infection. Most recent papers are from countries that have not managed to control their TB. TB disease is common in most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia.

Pai et al (2022) reviewed papers written on 67 patients and reported that "41 case reports and 7 case series were included, comprising data from 67 patients. The mean age was 40 years (range, 19-87 years) and the majority were female (n = 46, 68.7 %). The mean symptom duration was 12.8 months (range, 0.25-120 months). Common symptoms included otorrhea (n = 60, 89.6 %), HL (n = 58, 86.6 %), otalgia (n = 19, 28.4 %), and FP (n = 18, 26.9 %). Otoscopy revealed tympanic membrane (TM) perforation in 45 patients (67.2 %). Most patients were diagnosed with tissue biopsy (n = 53, 79.1 %). Surgical interventions were performed in 48 patients (71.6 %) and 63 patients (94.0 %) were prescribed anti-TB chemotherapy. Long-term sequelae (e.g., HL, FP, and TM perforation) were noted in 39 patients (58.2 %) at a mean follow-up of 18.8 months (range, 1-120 months)."

GENERAL SIGNS AND SYMPTOMS:

While tuberculosis is generally thought of as a lung disease, this is generally not true in persons with otic TB, where 83.3% are without lung disease (Rubio et al, 2015). TB can affect the middle ear and mastoid sinus, where it causes a discharge.

OTOLOGIC SIGNS AND SYMPTOMS

According to Rubio et al who reported a small number of cases (2015), the neuro-otologic manifestation was as follows: 85.7% sensorineural hearing loss; 42% polyneuropathy. 71.4% had granulation tissue. There are an immense number of other papers on otic TB, largely small case series.

TESTS

The main method of detecting TB in the US is to look for a positive skin test. This does not work in individuals who have had BCG immunization however.

Pathological tests involve cultures (which take a long time to grow) or staining for acid-fast bacilli of secretions or biopsies.

There is also a blood test for tuberculosis called the "quantiferon TB gold". It detects both latent and active tuberculosis. It should be negative in persons vaccinated with BCG or infected with enviromental mycobacteria. It works by measuring the amount of interferon-gamma released from patient T-cells after stimulation with 3 mycobacterial proteins. A similar blood test is called the "T-spot".

Chest-X rays can be used to screen for TB, but of course it will not detect TB involving other organs such as the brain, spine or kidneys.

TREATMENT

Otic TB is generally treated with the same medications as used for pulmonary TB (Kwon et al, 2010). Standard treatment includes isoniazide, rifampin, and other specialized medications (Bonfioli et al, 2005). Sometimes tuberculosis is treated with powerful aminoglycoside antibiotics such as streptomycin. When this is done, the antibiotic may damage the inner ear.

References