RESUMO
OBJECTIVES: To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases. CASE REPORT: We report four cases of tuberculous otitis media with different clinical presentations, encountered between 1998 and 2002. None of the cases showed improvement with local or systemic antibiotics. The diagnosis, complications and management of these cases are discussed. CONCLUSIONS: A high index of clinical suspicion of tuberculous otitis media is required in patients who do not respond to standard antibiotic therapy for (nontuberculous) chronic middle-ear infection. Early diagnosis and treatment of tuberculous otitis media is important to avoid irreversible complications, surgical intervention and propagation of the disease.
Assuntos
Otite Média Supurativa/diagnóstico , Tuberculose/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Audiometria de Tons Puros , Pré-Escolar , Diagnóstico Diferencial , Dor de Orelha/etiologia , Paralisia Facial/diagnóstico , Paralisia Facial/cirurgia , Feminino , Tecido de Granulação/microbiologia , Perda Auditiva Condutiva-Neurossensorial Mista/diagnóstico , Perda Auditiva Condutiva-Neurossensorial Mista/etiologia , Humanos , Malásia/epidemiologia , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Otite Média Supurativa/etiologia , Otite Média Supurativa/terapia , Radiografia , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/terapia , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológico , Perfuração da Membrana Timpânica/etiologia , Adulto JovemRESUMO
BACKGROUND: Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency. AIM: We report two patients presenting with spinal stenosis and cord compression secondary to cranio-vertebral tuberculosis, who were successfully decompressed via an endoscopic, endonasal approach. STUDY DESIGN: Two case reports. METHODS AND RESULTS: Both patients were successfully decompressed via an endoscopic, endonasal approach which provided access to the cranio-vertebral junction and upper cervical spine. CONCLUSION: An endoscopic, endonasal approach is feasible for the surgical management of cranio-vertebral junction stenosis; such an approach minimises surgical trauma to critical structures, reducing post-operative morbidity and the duration of hospital stay.
