Clinical characteristics of tuberculous otitis media: when to sound the alarm?

Background: Tuberculous otitis media (TOM) is a rare form of chronic otitis media, which presents diagnostic challenges due to nonspecific symptoms.

Aims/objectives: To characterize the clinical features and identify strategies for early diagnosis.

Materials and methods: A retrospective analysis was conducted on 32 patients (40 ears) diagnosed with TOM between 2002 and 2024. Clinical, audiologic, radiologic, and laboratory findings were reviewed.

Results: Mean diagnostic delay was 28.9 months. Persistent otorrhea (90%) and hearing loss (HL) (100%) were predominant. Tympanic membrane findings varied: single perforation (70%), multiple (12.5%), and intact (17.5%). Granulations were universal. Age stratification revealed conductive HL and pneumatized mastoids predominated in patients <40 years, while mixed HL and mixed-type mastoid were more common in patients >40 years (p = 0.016, p = 0.005). Bone destruction was evident in 25% of the cases. Mastoid type correlated with HL patterns in non-destructive cases (p = 0.040). Interferon-gamma release assay (IGRA) and polymerase chain reaction (PCR) showed relatively high detection rates.

Conclusions and significance: Early suspicion of TOM in refractory/recurrent otitis media, combined with IGRA/PCR screening, prompt imaging, and consideration of age-specific patterns, facilitates timely diagnosis. Surgical biopsy remains critical for confirmation. Integration of age-stratified clinical, laboratory, and radiological findings improves detection accuracy and patient outcomes.