Extra-laryngeal head and neck tuberculosis

Objective Extra-laryngeal head and neck tuberculosis is exceptional Therefo re, a retrospective multicenter study in patients with head and neck tuberc ulosis, excluding solitary lymphadenitis and laryngeal locations was carrie d out. Methods We reviewed the patients with these features and tuberculosis confi rmation by culture and/or histologic granuloma with presence of acid-fast b acilli (AFB). Results We found 16 patients with the following locations: eight in oral ca vity and/or pharynx, four in ear, two in salivary glands, one in nose and o ne in frontal sinuses. The average duration of symptoms was 11.5 months. Pu rified protein derivative (PPD) was positive (> 10 mm) in all but one patie nt in whom it was performed (six of seven). Except tuberculous otitis, whic h occured without reactive lymphadenitis, this was present in 50% of the re st (six of the 12). In all cases a biopsy was required for diagnosis. Only in four patients, all with pharyngeal locations, was coincident pulmonary t uberculosis confirmed. One patient with tuberculous otitis developed mening itis and died; three additional patients (two with otitis) were cured but w ith sequelae: the evolution of the remaining patients was satisfactory with medical therapy. Conclusions Extra-laryngeal head and neck tuberculosis has a slow course. T he diagnosis is difficult due to the common absence of lung involvement and the usual requirements for biopsy procedures. The outcome is usually favor able with antituberculous drugs alone although in tuberculous otitis there are possibilities of complications.