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The Diagnosis and Treatment of Middle Ear Cholesteatoma with Tuberculous Otitis Media Co-infection: A Series of 11 cases

Presenting Author: Franco Louie Abes

Published online by Cambridge University Press:  03 June 2016

Franco Louie Abes ,
Generoso Abes ,
Teresa Luisa Gloria-Cruz  and
Cecilia Montalban
Franco Louie Abes
Affiliation:
Manila Doctors Hospital; University of Santo Tomas Faculty of Medicine and Surgery; Asian Hospital and Medical Center; University of the Philippines National Institutes of Health Philippine National Ear Institute
Generoso Abes
Affiliation:
Manila Doctors Hospital; University of the Philippines Philippine General Hospital - Department of Otorhinolaryngology; University of the Philippines National Institutes of Health Philippine National Ear Institute
Teresa Luisa Gloria-Cruz
Affiliation:
University of the Philippines Philippine General Hospital Department of Otorhinolaryngology; University of the Philippines National Institutes of Health Philippine National Ear Institute
Cecilia Montalban
Affiliation:
Manila Doctors Hospital
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Abstract

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Introduction: Tuberculosis is thought to be an endemic disease in the Philippines wherein there have been a number of documented tuberculous otitis media (TOM) cases. The suspicion of TOM co-infection among patients with cholesteatoma of the middle ear (CME) has led to this investigation.

Objectives: 1.) To describe the clinical features and the treatment outcomes of patients with CME and co-existent TOM. 2.) To compare the features of TOM with CME to that of TOM without cholesteatoma.

Study Design: Retrospective review of cases.

Setting: Tertiary private hospital.

Patients: 11 out of 73 patients were diagnosed with TOM and co-existent CME from January 2009-September 2014.

Interventions: Pure tone audiometry, CT-scan, PPD skin test, chest x-ray , PCR and histopathologic examinations were used as diagnostic procedures. The patients underwent single-stage tympanoplasty with mastoidectomy and anti-tuberculosis pharmacotherapy.

Main Outcome Measures: Otoscopic, audiometric and clinical evaluations were done upon follow-up.

Results: The primary clinical feature among our cases was the presence of cholesteatoma and chronic otorrhea. No residuals or recurrences were noted upon follow-up of the patients. The mean air-bone gap improvement after surgery and pharmacotherapy was 10.5 dB. The detection of tuberculosis infection was detected via PCR in all of the 11 patients with TOM and CME. CT-scan findings showed that the majority of TOM with CME patients exhibited various characteristics that are not present in TOM alone. Most of the TOM with CME patients exhibited positive PPD test results while exhibiting negative chest x-ray results.

Conclusions: The clinical and radiologic features of our TOM with CME patients were notably different from the more frequently reported TOM cases without CME. Modest short-term treatment outcomes can be achieved when antituberculosis medical therapy is adequately given after cholesteatoma surgery among TOM with CME patients.