Extrapulmonary Tuberculosis in Otorhinolaryngology: Clinical Manifestations and Overview

Abstract

INTRODUCTION:

Tuberculosis (TB) is a chronic granulomatous, infectious and communicable disease caused by Mycobacterium tuberculosis.A prospective study of patients who presented to us, at a tertiary care hospital, primarily with TB of head and neck was done from June 2023 to July 2024. Patients were categorised into proper category of Anti Tuberculous Treatment (ATT) and were treated according to ATT regimen. The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties and to evaluate efficacy of treatment regimen. All patients were followed up at 3 months and 6 months after starting ATT. A total of 75 patients presented with primary head and neck TB during the study period.

MATERIALS AND METHODS:

Detailed history was obtained from all the patients. After obtaining history, a detailed clinical examination including General Examination, Systemic Examination and E.N.T. examination was done.All routine investigations were carried out. X ray chest, Sputum AFB and HIV Testing was done for all the patients. Relevant investigations were carried out according to presenting complaint. After diagnosis of Tuberculosis was made these patients were categorised into proper category of Anti Tuberculous Treatment (ATT).

RESULT:

Most of these (80%) had cervical lymphadenopathy, 8 patients of tubercular otitis media, 3 patients had laryngeal TB, 2 patients had salivary gland tuberculosis, and there was 1 patient each of oral TB & TB perichondritis. 39 were females, and 36 were males. Maximum number of patients were from 21-30 years of age group. In 2 patients of TB otitis media, diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing was improved.

CONCLUSION:

{1} Diagnosing TB requires a high index of suspicion & proper tissue diagnosis. As the symptoms of  EPTB in otorhinolaryngology are varied; hence, all otorhinolaryngologists should be aware of the manifestations of EPTB to suspect and diagnose/ rule out by specific investigations.  {2} Tuberculosis of the cervical lymph nodes is the commonest presentation followed by TB otitis media. {3} Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, Histopathological examination is gold standard & newer diagnostic tests such as CBNAAT increases the yield of positive cases and should be used whenever required. {4} In the larynx, true vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. {5} Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. {6} Category I ATT is effective.