TB Ear Symptoms and Diagnosis

TM Defects

• Locations of TM defects: Pars flaccida, Postero-superior marginal, Sentinel or inflammatory polyp.

TB Ear

• Characterized by otorrhoea unresponsive to treatment, exposed bone and ossicles, and multiple perforations.
• Facial nerve (CN VII) palsy may occur.
• 50% of patients may have disseminated TB or pulmonary TB (PTB).
• In South Africa, a runny ear with facial nerve palsy suggests TB until proven otherwise.

Bloody Otorrhoea

• Caused by traumatic perforation of the tympanic membrane (TM) through:
  • Penetrating injury
  • Pressure changes (diving or flying) or explosions
  • Skull base fractures
• Symptoms include bloody otorrhoea, possible hearing loss, balance issues, and blood in the external auditory canal (EAC).

CSF Otorrhoea

• Indicative of a skull base fracture with signs such as:
  • Battle sign (mastoid bruise)
  • Raccoon eyes (periorbital bruising)
  • Halo sign (CSF otorrhea/rhinorrhea)
  • Hemotympanum
• Hearing loss may be conductive (TM rupture/ossicular chain disruption) or sensorineural (cochlear injury).
• Nystagmus and vertigo can occur if the vestibular apparatus is affected.

Barotrauma

• Results from pressure differences between the environment and the middle ear (ME).
• Causes:
  • Descent leads to increased atmospheric pressure and a relative vacuum in the ME
  • Ascent allows air to escape passively
• Valsalva maneuver helps to equalize pressure.

Asymptomatic Ear Diseases

• Conditions that may never present include:
  • Otitis media with effusion
  • Otosclerosis
  • Tympanosclerosis
  • Exostoses

Otitis Media with Effusion (OME)

• A condition where fluid accumulates in the middle ear behind an intact TM.
• Often follows acute otitis media (AOM) or is caused by inadequate ventilation via the Eustachian tube, particularly in children.
• Symptoms may include mild to moderate conductive hearing loss and speech impairment.

Otosclerosis

• Characterized by abnormal bone fixation of the stapes footplate.
• Typically familial or spontaneous, causing bilateral conductive hearing loss without prior trauma or infections.

Tympanosclerosis

• Involves scar tissue formation in the middle layer of the TM.
• Usually maintains normal drum mobility with normal hearing, though ossicular involvement can occur occasionally.

Exostoses

• Known as "surfer's ear," occurs when the external auditory canal becomes obstructed by bony overgrowth due to prolonged cold water and wind exposure.

Perichondritis of the Pinna

• Symptoms include pain, induration, erythema, and possibly abscess formation.

Complications of Perichondritis

• May lead to "cauliflower ear," where cartilage distortion occurs due to replacement with fibrous tissue.

Ramsey Hunt Syndrome (Herpes Zoster Oticus)

• A reactivation of the varicella zoster virus in the ear.
• Symptoms include vesicles in the auricle/EAC and potential facial nerve palsy.
• Higher incidence in immunocompromised individuals.

Acute Otitis Externa (AOE)

• AOE or swimmer's ear can be diffuse or localized (furunculosis).
• Symptoms of diffuse AOE include pain on auricle manipulation, inflamed EAC, and scanty discharge.
• Localized AOE is caused by Staphylococcus aureus, presenting with severe otalgia.

Otomycosis

• A fungal infection typically caused by Aspergillus or Candida species.
• Symptoms mirror those of diffuse AOE, including pain and scanty otorrhoea.

Necrotizing Otitis Externa

• A severe infection affecting the EAC and skull base, commonly mistaken for malignancy.
• Predominantly seen in immunocompromised patients, presenting with severe pain and possible progression to osteomyelitis.

External Auditory Canal (EAC) Tumours

• Tumors mainly arise from the skin of the pinna entering the EAC.

This quiz explores the symptoms and diagnostic criteria related to TB ear, including effects on the tympanic membrane, facial nerve involvement, and potential systemic dissemination of tuberculosis. Test your understanding of these critical medical concepts and their implications for patient care.