Unusual Inflammatory Lesions

Tuberculous otitis media is an unusual form of chronic otitis media, which is generally associated with active pulmonary tuberculosis. In the initial stages multiple perforations of the tympanic membrane develop. Granulations in the middle ear may appear pale and are often profuse. Complications, especially involvement of the facial nerve, are more frequent than in the commoner form of chronic otitis media. The diagnosis is usually made by histopathological examination of biopsy material from middle ear contents. This is often delayed because surgeons are reluctant to take biopsies from cases of chronic otitis media that seem fairly typical.

Culture of middle ear inflammatory tissue may produce tubercle bacilli. Histological examination shows tuberculoid granulation tissue composed of epithelioid cells, Langerhans giant cells and areas of caseation situated in the middle ear mucosa. There is much bone destruction. Acid-fast bacilli are found with difficulty in the granulomatous material.

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