Tuberculous otitis: an underdiagnosed disease.

A series of 31 cases (33 ears) of tuberculous otitis was reviewed. Classical findings of the disease, such as painless ottorhea and multiple perforations of the tympanic membrane, are not consistent with the clinical findings reported here. Severe conductive hearing loss, abundant pale granulations, and an eroded malleus handle occur consistently and appear to be important clinical features of the disease. In all cases suspected of tuberculosis, granulation tissue from the middle ear or mastoid was submitted for bacteriologic and histologic examination. As a result, tuberculous otitis was diagnosed in its early stages. In 10 patients (32%), pulmonary tuberculosis was found following confirmation of the tuberculous otitis media. Following 6 months of treatment with oral antituberculous therapy in conjunction with surgery, no evidence of active tuberculosis was present in any of the patients studied.