TUBERCULOUS OTITIS-MEDIA

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear and mastoid. The increasing incidence of t uberculosis in the United States may be associated with more cases of TOM than recognized previously. Patients typically have a chronic tymp anic membrane perforation and ear drainage associated with progressive and profound hearing loss. The correct diagnosis starts with consider ation of the disease in a patient with a chronic middle ear infection that is unresponsive to routine therapy. TOM should be strongly consid ered in patients with known or suspected tuberculosis and a chronic ea r infection; however, the lack of evidence of tuberculosis elsewhere d oes not exclude the possibility of TOM. Appropriate evaluation for TOM includes a chest film, purified protein derivative (PPD) skin testing , and smears or cultures of otic secretions for mycobacteria. Operativ e biopsy may be required. Facial nerve paralysis is highly suggestive of TOM. Medical therapy with antituberculous drugs is usually effectiv e, and surgery is rarely needed.