A Case of Bilateral Tuberculous Otitis Media That Was Difficult to Diagnose

While tuberculosis (TB) is on the decline in Japan, the incidence is higher than that in other industrialized countries. Among cases of extrapulmonary TB, tuberculous otitis media is rare, and the diagnosis is often delayed because of the variety of symptoms. We report a case of tuberculous otitis media in a patient who was diagnosed as having pulmonary TB during treatment for refractory otitis media and the middle ear lesions improved with antituberculosis drug therapy. The patient, a 26-year-old woman with the complaints of hearing loss and otorrhea visited our hospital after the hearing loss failed to improve with treatment provided by a local doctor. On examination, her external auditory canal was swollen, the tympanic membrane could not be visualized, and an audiogram showed bilateral conductive hearing loss. Auricular CT showed bilateral mastoid apicitis and soft shadows in the tympanic chamber, without bony destruction. Suspecting eosinophilic otitis media or ANCA-associated vasculitis otitis media, we started the patient on steroid treatment and performed ear washing, but the patient’s symptoms deteriorated. A QFT was performed on the suspicion of tuberculous otitis media, and a chest CT revealed findings suggestive of pulmonary TB, which was confirmed by transbronchial lung biopsy. After the patient was started on antituberculosis drug therapy, her symptoms improved. Since the patient’s refractory otitis media improved with treatment administered for pulmonary TB, we made a clinical diagnosis of tuberculous otitis media. In patients presenting with refractory otitis media, tuberculous otitis media should be considered in the differential diagnosis and aggressive examination should be performed to rule out the disease.