Jesic et al reported criteria for the diagnosis of middle ear tuberculosis. This can be a diagnostic challenge requiring a high index of suspicion. The authors are from the Clinical Centre of Serbia in Belgrade.
Clinical features
(1) facial nerve palsy
(2) sensorineural hearing loss
(3) ear discharge of relatively short duration (only a few months)
(4) extensive temporal bone destruction on imaging studies
(5) variable fistula of the labyrinth and/or fallopian canal destruction
(6) variable evidence of miliary tuberculosis
(7) reason to suspect tuberculosis (exposure history, illness course, high risk community)
The condition may be seen in patients with known tuberculosis, but it also can be the initial finding.
Diagnosis can be challenging due to:
(1) scant specimen (diagnostic material)
(2) very small number of organisms
(3) false negative PCR
The main differential diagnosis is cholesteatoma.
