Ankit Gulati et al 104 IJAIMS Tuberculosis of Middle Ear 1 Ankit Gulati, 2 Vikas Kakkar, 3 Chandni Sharma, 4 Mohit Pareek, 5 Surender Bishnoi ABSTRACT A 32-year-old female presented with a history of otorrhea and hearing loss in her right ear since 2 years. On examination, external auditory canal was found to be flled with polypoidal tissue along with mucopurulent discharge. Audiometry showed mixed hearing loss of 50, 55, and 60 dB with air-bone gap of 30, 35, and 40 dB at frequencies of 0.5, 1, and 2 kHz respec- tively. She was operated for the same, and biopsy was sent for histopathological examination, which showed granulomatous infammation. The patient was treated with antituberculous therapy, and she responded fully to the treatment. Keywords: Otorrhea, Pale granulation tissue, Tuberculous otitis media. How to cite this article: Gulati A, Kakkar V, Sharma C, Pareek M, Bishnoi S. Tuberculosis of Middle Ear. Int J Adv Integ Med Sci 2017;2(2):104-105. Source of support: Nil Confict of interest: None INTRODUCTION Tuberculosis (TB) can attack almost every organ in the human body and threatens millions of lives worldwide. Approximately one-third of total human population is infected by Mycobacterium tuberculosis. 1 India is the country with the highest burden of TB, with the World Health Organization statistics for 2013 giving an esti- mated incidence fgure of 2.1 million cases of TB for India out of a global incidence of 9 million. 2 Tuberculosis can be pulmonary or extrapulmonary. Extrapulmonary contributes 12 to 15% of all cases of which middle ear TB constitutes less than 1%. The incidence of tuber- culous otitis media (TOM) is 1.9 to 42.8 per million. Mycobacterium tuberculosis is the most common agent causing TB worldwide. 1 CASE REPORT 10.5005/jp-journals-10050-10086 CASE REPORT A 32-year-old female presented with a 2-year history of right-sided otorrhea and hearing loss. The discharge was insidious in onset, scanty, mucopurulent, nonfoul smelling, and occasionally stained with blood. Hearing loss was insidious in onset and gradually progressive. Otoscopy revealed edema of the external auditory canal with polypoidal tissue seen arising from the posterosu- perior quadrant of tympanic membrane. Audiometry showed mixed hearing loss of 50, 55, and 60 dB with air- bone gap of 30, 35, and 40 dB at frequencies of 0.5, 1, and 2 kHz respectively. The patient was treated with topical and systemic antibiotics with no relief for which the patient was investigated and was diagnosed as diabetic. She was put on oral hypoglycemic agents, but there was no relief in discharge despite adequate blood sugar control. The discharge was sent for culture and sensitiv- ity, which was reported sterile. As there was no relief in symptoms of the patient, modifed radical mastoidectomy was performed. Intraoperatively, the middle ear was found to be flled with exuberant and pale granulation tissue, which was removed and sent for histopathological examination. The long process of incus was necrosed. Histopathological examination showed giant cells and macrophages with necrotic and calcifed tissue (Fig. 1). On the 10th postoperative day, external auditory canal was found to be flled with discharge along with gaping of the postauricular incision, which led to suspicion of the patient suffering from TOM. The patient was then investigated to rule out tuberculous etiology. Chest X-ray, 1 Senior Resident, 2 Senior Professor, 3 Assistant Professor 4 Junior Resident, 5 Consultant 1 Department of ENT, Adesh Medical College & Hospital, Ambala Haryana, India 2-4 Department of ENT, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India 5 Haryana Civil Medical Services, Haryana, India Corresponding Author: Ankit Gulati, Senior Resident Department of ENT, Adesh Medical College & Hospital, Ambala Haryana, India, e-mail: gulati.ankit07@gmail.com Fig. 1: Histopathological section showing giant cells (red arrow) and necrosis (green arrow) (hematoxylin and eosin, 40×)