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[Primary tuberculosis of the middle ear: description of 2 cases and review of the literature].
Tubercolosi primitiva dell'orecchio medio: descrizione di due casi e revisione della Letteratura.
Recently, a recrudescence of tuberculosis (TBC) as been found, even in Western world and in Italy, most likely in relation to the increase in immigration from developing countries and to the pathologies that cause immunodepression. The present paper reports two cases of primitive TBC of the middle ear, both coming under observation for facial paralysis. These cases highlight the clinical-therapeutic features of this disease, the difficulty in diagnosis and the need to include TBC in the differential diagnosis of phlogistic processes of the middle ear. The clinical-diagnostic features of presented cases focus attention on the consideration of TBC in the differential diagnosis of chronic otitis, particularly in presence of unusual symptoms, such as facial paralysis, and in case of otitis with rapid onset, unresponsive to conventional treatment. In one case, first examination of the ear showed normal tympanic membrane (absence of any tympanic perforation) and normal timpanometry; these facts steered diagnosis away from a middle ear phlogosis pathology. Both cases showed how radiological semeiology, CT and NMR are not enough to diagnose the nature of the disorder, particularly in case of cholesteatoma. Moreover, both patients were in good general conditions at the time of the examination, they didn't show history of previous immunodepression or other risk factors. The cases reported call attention to the aspecific characteristics of the onset of primitive tuberculous otitis media and difficulty in making a diagnosis. They underline the need for post-operative anti-tuberculous chemotherapy which provided a rapid and definitive resolution of infectious process.
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