Kirsch C M, Wehner J H, Jensen W A, Kagawa F T, Campagna A C
Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose 95128.
South Med J. 1995 Mar;88(3):363-6. doi: 10.1097/00007611-199503000-00024.
Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear and mastoid. The increasing incidence of tuberculosis in the United States may be associated with more cases of TOM than recognized previously. Patients typically have a chronic tympanic membrane perforation and ear drainage associated with progressive and profound hearing loss. The correct diagnosis starts with consideration of the disease in a patient with a chronic middle ear infection that is unresponsive to routine therapy. TOM should be strongly considered in patients with known or suspected tuberculosis and a chronic ear infection; however, the lack of evidence of tuberculosis elsewhere does not exclude the possibility of TOM. Appropriate evaluation for TOM includes a chest film, purified protein derivative (PPD) skin testing, and smears or cultures of otic secretions for mycobacteria. Operative biopsy may be required. Facial nerve paralysis is highly suggestive of TOM. Medical therapy with antituberculous drugs is usually effective, and surgery is rarely needed.
结核性中耳炎（TOM）是慢性化脓性中耳和乳突感染的罕见病因。美国结核病发病率的上升可能导致比以往认识到的更多的结核性中耳炎病例。患者通常有慢性鼓膜穿孔和耳漏，并伴有进行性重度听力损失。正确的诊断始于对常规治疗无反应的慢性中耳感染患者考虑该病。对于已知或疑似患有结核病且有慢性耳部感染的患者，应高度怀疑结核性中耳炎；然而，其他部位缺乏结核病证据并不排除结核性中耳炎的可能性。结核性中耳炎的适当评估包括胸部X光片、结核菌素纯蛋白衍生物（PPD）皮肤试验，以及耳部分泌物的涂片或培养以查找分枝杆菌。可能需要进行手术活检。面神经麻痹强烈提示结核性中耳炎。抗结核药物的药物治疗通常有效，很少需要手术。
