Diagnostic experience of tuberculosis otitis media, a rare recognized extrapulmonary tuberculosis

Extrapulmonary tuberculosis (EPTB) remains a challenge in the diagnosis and treatment. Tuberculosis otitis media (TBOM) is a rare and challenging form of EPTB due to its varied presentation and rare incidence. Early and timely diagnosis of TBOM is crucial for treatment. In this study, we sought to gain a better understanding of the varied clinical presentations and imaging diagnostic information for TBOM. This was a retrospective review of TBOM cases that were treated at our department, between September 2019 and June 2025. Summarizing their clinical characteristics, diagnosis, and treatment. All participants underwent the temporal bone High-Resolution Computed Tomography, and middle ear status was assessed using four sections: mesotympanum, attic, antrum and mastoid air cells. Twelve cases of TBOM, 10 female and 2 male patients, median age was 33 years, were included in the study. TBOM mainly presents with symptoms of otorrhea, hearing loss, and tinnitus. Inflammation also affects the unaffected ear, with TBOM showing greater specificity on the affected side compared with patients with common otitis media. The unaffected ear in particular almost always provides good ventilation in TBOM. Middle ear surgery and Anti-tubercular treatment (ATT) were completed in all cases. The average follow-up was 10 months. No cases of TBOM relapses were observed. EPTB requires high clinical suspicion and a multidisciplinary approach for diagnosis and treatment. We highlight that characteristic imaging manifestations and clinical symptoms should be attracted high attention for cases with high suspicion of TBOM.