OVERVIEW
Overview of tuberculosis of the external ear
Tuberculosis of the external ear is extremely rare and most often results from the spread of tuberculosis of the facial skin. Tuberculous mastoiditis of the middle ear is most often secondary to other tuberculous lesions, mainly pulmonary tuberculosis, but can also be caused by adenoidal tuberculosis or by the spread of bone or joint tuberculosis and cervical lymphatic tuberculosis. Pathogenic bacteria may invade the middle ear through the Eustachian tube, or pass into the middle ear and mastoid via the blood circulation or lymphatic system. The disease is more common in infants and young children.
Whether medical insurance
Yes
Department
Otorhinolaryngology, Infectious Diseases, Pediatrics
Clinical symptoms
Obstructive sensation in the ear, tinnitus, pus, deafness, multiple perforations of the tympanic membrane, etc.
Hazards
If the lesion invades into the skull, tuberculous meningitis may complicate.
Examination
Laboratory examination (blood routine, etc.), pathogenetic examination (tuberculin test, smear, specific antibody determination, molecular biology examination, etc.), ear specialist examination, imaging examination (X-ray film, CT), pathological histological examination, etc.
Diagnosis
Diagnosis is made on the basis of medical history, clinical manifestations such as deafness and multiple perforations of the tympanic membrane, combined with the results of pathogenetic examinations, X-rays, CT examinations, and pathologic histologic examinations.
Treatment principle
Early treatment with anti-tuberculosis drugs and surgery if necessary.
Curable
Symptoms can be improved by active treatment.
Dietary recommendations
Eat high-calorie, high-protein, high-vitamin foods.
Causes
Causes
The disease is caused by Mycobacterium tuberculosis infection.
Symptoms and Diagnosis
Typical symptoms
At the beginning, most patients have no symptoms. Later on, there may be a sudden sensation of obstruction or tinnitus in the ear, pus flow, thin, watery or milky pus with yellowish color, and foul smell, without pain. If the infection is mixed, there may be redness, swelling, heat and pain. Deafness appears early, rapidly aggravated, initially conductive deafness, hearing threshold is often 50 ~ 60 dB HL, if the lesion invades the inner ear, it is manifested as mixed or sensorineural deafness. Typical lesions of the tympanic membrane are multiple perforations, which often rapidly fuse to become a single large perforation with a margin up to the tympanic groove. The mucosa of the tympanic cavity is pale and edematous, and a large amount of pink or pale granulation tissue may form within the tympanic cavity. If there is destruction of the facial nerve canal and labyrinthine bone, facial paralysis and vertigo occur. Multiple postauricular fistulas can be formed if the lateral mastoid bone wall is destroyed and pierced to the back of the ear. The lymph nodes around the ear are often enlarged and painless.
Diagnostic basis
1. History of tuberculosis. 2. Clinical manifestations: sudden onset of obstruction or tinnitus in the ear, pus, pus is thin, watery or milky with a yellowish color and a foul smell, no pain. If mixed infection, there may be redness, swelling, heat and pain. Deafness appears early, rapidly aggravated, initially conductive deafness, hearing threshold is often 50 ~ 60 dB HL, if the lesion invades the inner ear, it is manifested as mixed or sensorineural deafness. Typical lesions of the tympanic membrane are multiple perforations. The mucosa of the tympanic chamber is pale and edematous, and there may be a large amount of pink or pale granulation tissue formation within the tympanic chamber. If there is destruction of the facial nerve canal and labyrinthine bone, facial paralysis and vertigo occur. Multiple postauricular fistulas can be formed if the lateral mastoid bone wall is destroyed and pierced to the back of the ear. The lymph nodes around the ear are often enlarged and painless.3. Auxiliary examination (1) Tuberculin test: positive. (2) X-ray of mastoid or CT of temporal bone: it shows blurring of mastoid airspace and formation of dead bone. (3) Pathologic and histologic examination: it is the main diagnostic basis for ear tuberculosis.
Treatment
Treatment guidelines
Early treatment with anti-tuberculosis drugs and surgery if necessary. If appropriate, mastoid surgery should be performed to remove the lesion, or facial nerve decompression surgery, tympanoplasty, etc.
Radiotherapy
Anti-tuberculosis chemotherapy.
Surgery
If there is dead bone formation, fistula behind the ear or poor local drainage in middle ear mastoid tuberculosis, mastoid surgery should be performed to remove the lesion when the patient’s general condition is good; if the patient is complicated by facial paralysis, decompression of facial nerve is needed, and tympanoplasty should be performed at a later stage.
Other treatments
Attention to rest, strengthen nutrition, symptomatic treatment.
Prognosis
The prognosis is generally good after active treatment.
Nursing care
Daily care
1. Open the windows regularly to keep the indoor air fresh and the temperature and humidity suitable. 2. Live a regular life and ensure enough sleep. 3. Instruct the patients to follow the doctor’s instructions to use the medication, and do not increase, decrease or stop the use of medication by themselves. 4.
Diet
Eat high-calorie, high-protein, high-vitamin food.