Primary bilateral tuberculous otitis media with peripheral facial paralysis: a case report and literature review.

Tuberculous otitis media (TOM) is a rare disease. This study presents our experience in the diagnosis and treatment of TOM. A 49-year-old female had repeated ear discharge, vertigo, and severe hearing loss for six years, and underwent mastoid surgery four times because she was misdiagnosed with chronic suppurative otitis media. The patient had left-sided facial paralysis for two weeks when she was admitted to our hospital and was managed with radical mastoidectomy and facial nerve decompression. After surgery, facial nerve function gradually improved from grade V to grade II, and the patient was diagnosed with an unusual primary bilateral TOM after tuberculosis smear culture, pathologic examination, and tuberculosis DNA testing by the PCR technique. After anti-tuberculosis therapy, the operative mastoid cavity in the patient was eventually epithelialized and dry. Therefore, this study suggests that, TOM should be actively excluded in patients with uncontrollable ear leakage, massive white granulation tissue and dead bone formation in the ear. Surgical decompression is recommended to prevent permanent facial paralysis, since opening the facial nerve sheath effectively relieves facial nerve compression and edema due to the TOM-induced persistent inflammation and granulation tissue formation.