Tuberculous otitis media in pediatrics, a diagnostic challenge. Case report and literatura review

Abstract

Tuberculosis is one of the leading causes of child mortality, with a mortality rate of up to 40% in cases between 0 and 4 years old. An uncommon form is tuberculous otomastoiditis (TOM), which poses a diagnostic challenge and has severe consequences such as destruction of the middle ear, hearing loss, and intracranial dissemination. Clinical case: We present the case of an 8-month-old infant with poor pediatric control and malnutrition, where otic tuberculosis was a secondary finding due to persistent otorrhea in the context of dis­seminated tuberculosis and multiple other infections. Discussion: The diagnosis of TOM is a diagnostic challenge given the nonspecific presentation. Classically, it is characterized by persistent otorrhea despite treatment, hearing loss, and facial paralysis, with microsco­py showing pale granulations and multiple tympanic perforations. Traditional diagnostic methods have poor performance, with Koch’s culture achieving a sensitivity of up to 35%, while DNA-based tests reach 95% sensitivity. The initiation of antituberculosis therapy is crucial for the prevention of local complications and dissemination, while surgical interven­tion is reserved for cases with complications.