Thomas Nittu, Nambiar Sapna Sreedharan, Nampoothiri P Muraleedharan
Department of ENT, Government Medical College, Kozhikode, Kerala India.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):5562-5568. doi: 10.1007/s12070-021-02903-3. Epub 2021 Oct 8.
The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP.
Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions.
The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis.
A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.
本研究旨在确定头颈部肺外结核（EPTB）在耳鼻咽喉区域的临床表现及流行病学特征。近年来，由于免疫功能低下状态的增加和耐药菌的出现，EPTB的发病率有所上升。耳鼻咽喉区域EPTB的临床症状和体征与耳鼻咽喉科的恶性肿瘤及其他疾病重叠，因此需要早期正确诊断，以避免不必要的手术和操作，并根据国家结核病控制规划（RNTCP）启动适当的抗结核治疗。
我们对印度南部一家三级医疗中心耳鼻咽喉科门诊在18个月期间确诊为耳鼻咽喉区域EPTB的45例患者进行了前瞻性研究。
该研究纳入了29例（64.4%）出现颈部淋巴结肿大的患者、11例（24.4%）患结核性喉炎的患者、3例（6.6%）患结核性中耳炎的患者以及各1例患鼻腔和口腔结核的患者。在我们的研究中，6例（13.3%）患者合并肺结核，8例（18%）患有糖尿病，5例（11%）有结核病史，7例（16%）有结核病接触史。
对于（i）临床症状与体征不符、（ii）常规治疗无效或（iii）尽管接受治疗症状仍持续或复发的患者，必须高度怀疑EPTB。挑战在于确诊，这需要对组织标本进行组织病理学检查（HPE）。根据RNTCP及时诊断并启动抗结核治疗（ATT）有助于完全康复，从而降低发病率。
