СРПСКИ АРХИВ ЗА ЦЕЛОКУПНО ЛЕКАРСТВО 350 Snežana JEŠIĆ Dalmatinska

Tuberculous otitis media (TOM) is a rare form of chronic otitis media and extrapulmonary tuberculosis (TBC). Incidence of all forms of tuberculosis is 0.04-1% or 4% of head and neck tuberculosis [1]. In 1960 tuberculosis bacilli were isolated from the ear, much later than it was first isolated by Koch in 1882 [2]. TOM is the result of haematogenous spread of the infection in patients with other forms of TBC. Rarely, it is the result of infection imported through perforated tympanic membrane. In children, aspiration of infected milk through the Eustachian tube during drinking or nursing was a very common way of infection in the first half of the 20th century [3]. At that period half of the children younger than one year and 27% younger than two years had TOM [4]. This disease became considerably rare in children by making BSG vaccination obligatory and with pasteurization of milk. Today, TOM is uncommon and is rarely thought of. The classic description of TOM indicates multiple perforations of tympanic membrane, painful suppurative otorrhoea, and preauricular adenopathy, frequent complications like paralysis of the facial nerve, sensorineural hearing loss (SNHL) and association with pulmonary TBC. A recent description of the disease includes large tympanic perforation, conductive hearing loss that suddenly becomes sensorineural, with pale granulation tissue and dense secretion similar to infected cholesteatoma. Cervical lymphadenopathy and facial palsy are rare [5]. Making the diagnosis is difficult: the process lasts from 14 to 70 days, because the culture of the tissue or secretion is usually negative [1]. According to data, positive acidoalcohol fast bacilli (AFB) smears are uncommon (2-14%), while histopathological examination rarely indicates TBC granuloma, but more frequently necrotizing granuloma [6, 7, 8]. Polymerase chain reaction (PCR) testing represents the only hope, although there are opinions that this method is not reliable. The CT of the temporal bone does not necessarily indicate bone destruction.