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Kang YJ, Cho JH. A review of 280 nasopharyngeal tuberculosis cases and the effectiveness of antituberculosis treatments. J Clin Tuberc Other Mycobact Dis 2024; 36:100455. [PMID: 38983442 PMCID: PMC11231521 DOI: 10.1016/j.jctube.2024.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objectives Nasopharyngeal tuberculosis is a rare form of tuberculosis in which Mycobacterium tuberculosis infects the nasopharyngeal tissue. In this study, we analyzed key clinical features to prevent misdiagnosis and to raise awareness of the condition, while recommending suitable treatments. We also report a case of nasopharyngeal tuberculosis presenting with nasal congestion and intermittent ear fullness, contributing valuable educational insight for diagnosis. Methods Demographic and clinical data from patients with nasopharyngeal tuberculosis were collected from PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials up to September 2022. In total, 280 patients from 69 studies were analyzed. Results Reports indicate that the incidence of nasopharyngeal tuberculosis has doubled every decade, particularly in Asia. Most patients are female, presenting with granulomatous pathology and findings such as masses, lymphoid hyperplasia, polypoid formations, or swelling on endoscopic examination. Common symptoms include nasal obstruction, hearing impairment, sore throat, and dysphagia, usually accompanied by cervical lymphadenopathy. The mean duration from symptom onset to diagnosis is ∼2.88 months, and the average time from the start of treatment to resolution of symptoms is ∼ 4.90 months. The antituberculosis treatment regimen and duration are significantly associated with the time to resolution (r = -0.648, p = 0.003 and r = 0.584, p = 0.028, respectively). Conclusion These results suggest that an extended regimen of antituberculosis drugs may expedite symptom relief. However, there is a need for more standardized data on patient outcomes and treatment efficacy due to the current lack of comprehensive data.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Jin-Hee Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, South Korea
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Liu YC, Zhou ML, Cheng KJ, Zhou SH, Wen X. Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy: A case report. World J Clin Cases 2024; 12:3271-3276. [PMID: 38898839 PMCID: PMC11185384 DOI: 10.12998/wjcc.v12.i17.3271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Primary nasal tuberculosis (TB) is a rare form of extrapulmonary TB, particularly in patients receiving anti-tumor necrosis factor (TNF) immunotherapy. As a result, its diagnosis remains challenging. CASE SUMMARY A 58-year-old male patient presented to the ear, nose, and throat department with right-sided nasal obstruction and bloody discharge for 1 month. He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation. Biopsy findings revealed chronic granulomatous inflammation and a few acid-fast bacilli, suggestive of primary nasal TB. He was referred to our TB management department for treatment with oral anti-TB agents. After 9 months, the nasal lesions had disappeared. No recurrence was noted during follow-up. CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate, particularly when pathological findings suggest granulomatous inflammation.
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Affiliation(s)
- Yong-Cai Liu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou 310003, Zhejiang Province, China
| | - Min-Li Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ke-Jia Cheng
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xue Wen
- Department of Pathology, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
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Thomas N, Nambiar SS, Nampoothiri PM. Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:5562-5568. [PMID: 36742503 PMCID: PMC9895514 DOI: 10.1007/s12070-021-02903-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Objective 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. Study design 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. Results 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. Conclusion 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.
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Affiliation(s)
- Nittu Thomas
- Department of ENT, Government Medical College, Kozhikode, Kerala India
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4
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Sharma S, Rana AK. ENT manifestations of tuberculosis: an important aspect of ENT practice. Pan Afr Med J 2020; 36:295. [PMID: 33117489 PMCID: PMC7572661 DOI: 10.11604/pamj.2020.36.295.24823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.
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Affiliation(s)
- Shilpam Sharma
- Department of ENT, Vardhaman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Kumar Rana
- Department of Otorhinolaryngology and Head Neck Surgery, SRMS Institute of Medical Sciences, Bareilly (UP), India
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Khan S, Pujani M, Jetley S. Primary Nasal Tuberculosis: Resurgence or Coincidence - A Report of Four Cases with Review of Literature. J Lab Physicians 2020; 9:26-30. [PMID: 28042213 PMCID: PMC5015494 DOI: 10.4103/0974-2727.187921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Primary nasal tuberculosis (TB) is a rare form of TB even in areas with high TB incidence. It is timely diagnosis and proper management are often delayed due to its rarity and nonspecific clinical presentation. Aim: The aim of the study was to review histopathologically diagnosed cases of nasal TB over a period of 1 year and to describe its clinical presentation, diagnostic workup, the importance of histopathological diagnosis along with a brief review of the literature. Materials and Methods: This was a retrospective study done in the Department of Pathology of a Tertiary Care Hospital of Delhi over a period of 1 year where all the cases with histopathological diagnosis of nasal TB were reviewed. Patients' clinical details, investigations and treatment details along with follow-up were obtained from the medical records section. For each case, routine hematoxylin and eosin stain were studied along with Ziehl–Neelson staining. Results: A total of four patients were diagnosed with nasal TB histopathologically. Patients' age ranged from 5 to 34 with an equal male to female ratio. All patients were immunocompetent. Primary nasal TB was seen in all of the four cases. None of the cases, it was clinically suspected, and histopathology was the mainstay of diagnosis. All the cases were treated with antituberculous treatment and showed considerable improvement. Conclusions: Although nasal TB is rare, it should be considered in the differential diagnosis of chronic nasal symptoms and granulomatous lesions of the nose. Histopathology plays an important role in the diagnosis of these clinically unsuspecting cases of nasal TB.
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Affiliation(s)
- Sabina Khan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mukta Pujani
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Aggarwal N, Dutta M, Sinha R. Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Reactivation and Dissemination of Tuberculosis to Extrapulmonary Sites in Patients With Hematologic Malignancies. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Aggarwal N, Dutta M, Sinha R. Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:243-245. [PMID: 28803631 DOI: 10.1016/j.otorri.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Neeraj Aggarwal
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata 700073, West Bengal, India
| | - Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata 700073, West Bengal, India.
| | - Ramanuj Sinha
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata 700073, West Bengal, India
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9
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Primary Nasal Tuberculosis in a 10-Year-Old Girl. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:9128548. [PMID: 27366187 PMCID: PMC4904580 DOI: 10.1155/2016/9128548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
Abstract
Nasal tuberculosis is a rare clinical entity which mainly presents in elderly people. Nasal tuberculosis has always been considered to be secondary to tuberculosis of the lungs, and in rare instances it is a primary infection, usually when mycobacteria are inhaled. We describe the case of a 10-year-old girl who was successfully treated for primary nasal tuberculosis. This patient is one of the very few children who have been reported to have primary nasal tuberculosis.
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10
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Laudien M. Orphan diseases of the nose and paranasal sinuses: Pathogenesis - clinic - therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc04. [PMID: 26770278 PMCID: PMC4702053 DOI: 10.3205/cto000119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rare rhinological diseases are a diagnostic challenge. Sometimes it takes months or even years from the primary manifestation of the disease until the definitive diagnosis is establibshed. During these times the disease proceeds in an uncontrolled or insufficiently treated way. (Irreversible) damage results and sometimes life-threatening situations occur. The unexpected course of a (misdiagnosed) disease should lead to further diagnostic reflections and steps in order to detect also rare diseases as early as possible. The present paper discusses granulomatous diseases of the nose and paranasal sinuses caused by mycobacteria, treponema, Klebsiella, fungi, and protozoa as well as vasculitis, sarcoidosis, rosacea, cocaine-induced midline destruction, nasal extranodal NK/T cell lymphoma, and cholesterol granuloma. Furthermore, diseases with disorders of the mucociliary clearance such as primary ciliary dyskinesia and cystic fibrosis are presented, taking into consideration the current literature.
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Affiliation(s)
- Martin Laudien
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine of Kiel, Christian-Albrechts-University, Kiel, Germany
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11
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Nasal deformity due to tuberculous chondritis. Clin Exp Otorhinolaryngol 2014; 7:229-31. [PMID: 25177442 PMCID: PMC4135162 DOI: 10.3342/ceo.2014.7.3.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 02/22/2013] [Accepted: 03/26/2013] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) is a common disease worldwide. However, nasal TB is quite rare, and the diagnosis of nasal TB requires a high index of suspicion. The most common symptoms of this unusual presentation are nasal obstruction and nasal discharge. We present a case of nasal TB with involvement of the hard palate presenting with a chronically progressive nasal deformity and ulceration of the hard palate. A biopsy confirmed the diagnosis, and medication for TB was started and the lesions resolved. When a patient presents with chronic ulcerative lesions that do not respond to antibiotic treatment, TB should be included in the differential diagnosis. Biopsy of the lesion can aid in the confirmation of the diagnosis.
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12
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Ribeiro S, Ferreira B, Duarte R, Almeida I, Vasconcelos C. Primary nasal tuberculosis during anti-tumour necrosis factor alpha treatment of a patient with rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 45:957-60. [PMID: 23957541 DOI: 10.3109/00365548.2013.818246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anti-tumour necrosis factor alpha (anti-TNFα) therapy is increasingly used in several inflammatory disease processes, including rheumatoid arthritis. However it has a significant potential for adverse events, such as reactivation of latent tuberculosis, which is frequently found in disseminated or extrapulmonary forms. We present a rare case of primary nasal tuberculosis within the context of anti-TNFα therapy for rheumatoid arthritis. To our knowledge, this is the first reported case of primary nasal tuberculosis in a patient with rheumatoid arthritis receiving anti-TNFα therapy.
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Affiliation(s)
- Sofia Ribeiro
- Department of Internal Medicine, Hospital Santo António, Centro Hospitalar do Porto , Portugal
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13
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Akkara SA, Singhania A, Akkara AG, Shah A, Adalja M, Chauhan N. A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region. Indian J Otolaryngol Head Neck Surg 2013; 66:46-50. [PMID: 24605301 DOI: 10.1007/s12070-013-0661-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.
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Affiliation(s)
- Stani Ajay Akkara
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ankit Singhania
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ajay George Akkara
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India ; C-1, Staff Quarters, Sumandeep Vidyapeeth Campus, Vadodara, 391760 Gujarat India
| | - Arti Shah
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Mayur Adalja
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Nirali Chauhan
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
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14
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Lmekki S, Lecanu JB. Tuberculosis of the middle ear and nasal passage: A case report. Int J Mycobacteriol 2013; 2:51-3. [PMID: 26785789 DOI: 10.1016/j.ijmyco.2013.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/10/2013] [Accepted: 01/13/2013] [Indexed: 11/25/2022] Open
Abstract
The following report highlights the case of a 55-year-old female with nasal and middle ear tuberculosis. The diagnosis was confirmed using imagery, histopathological biopsy reports, and Polymerase chain reaction (TB-PCR). The patient was treated with rifampicin (10mg/kg), isoniazid (5mg/kg) and pyrazinamide (25mg/kg) for 9months. No recurrence was observed after one year of follow-up examination. Both nasal tuberculosis and tuberculous otitis media are currently considered rare diseases, yet if they are evaluated rapidly, there will be a good response to therapy without the need for surgery.
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Affiliation(s)
- Safaa Lmekki
- N°2 Résidence Ghita, rue Kamal Oudouane, ville nouvelle Fes 30000, Morocco.
| | - Jean Baptiste Lecanu
- Department d'O.R.L. et de chirurgie cervico-faciale, Institut Arthur Vernes 36, rue d'Assas, 75006 Paris, France
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15
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Grupper M, Potasman I. When uncommon uncovers: mucosal tuberculosis in a medical tourist from Burundi. J Travel Med 2012; 19:54-6. [PMID: 22221812 DOI: 10.1111/j.1708-8305.2011.00559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tuberculosis confined to the mucus membranes is a rare presentation in the era of effective chemotherapy. We describe a case of mucosal tuberculosis in a "medical tourist" from Burundi that went undiagnosed for 6 years. Starting as conjunctivitis, the disease has spread to involve the nose and larynx as well. The clinical, pathophysiological, and epidemiological aspects are discussed.
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Affiliation(s)
- Moti Grupper
- Infectious Disease Unit, Bnai Zion Medical Center, Haifa, Israel.
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Sachse F, Stoll W. Nasal surgery in patients with systemic disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc02. [PMID: 22073106 PMCID: PMC3199829 DOI: 10.3205/cto000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.
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Affiliation(s)
- Florian Sachse
- University of Münster, Department of Otorhinolaryngology Head and Neck Surgery, Münster, Germany
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17
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Yaneza MMC, Broomfield SJ, Morar P. 12 minute consultation: a patient with nasal crusting. Clin Otolaryngol 2011; 35:313-20. [PMID: 20738341 DOI: 10.1111/j.1749-4486.2010.02172.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nasal crusting is frequently encountered by the otorhinolaryngologist and often requires no specific treatment. It is, however, important to carry out a full history and examination, followed by appropriate investigations, in order to detect the small number of cases in which crusting is caused by systemic or malignant disease. METHODS This review was based on a literature search last performed on 30th July 2009. The MEDLINE, EMBASE and Cochrane databases were searched using the subject headings (nasal crusting OR crusts) and in combination with diagnosis, therapy and surgery. Similar searches were performed for relevant diseases, e.g. Wegener's granulomatosis, sarcoidosis. Results were limited to English language articles including clinical trials, meta-analyses, systematic reviews and review articles. Relevant references from selected articles were reviewed. RESULTS Knowledge of the causes of nasal crusting will help to target the history, examination and investigation of patients with this condition. Screening tests for systemic conditions can be useful but most have limited sensitivity and must be interpreted cautiously. Nasal septal biopsy is indicated when there is a suspicion of malignancy, or to support a suspected diagnosis of vasculitis. The treatment offered depends upon the cause of crusting and the severity of symptoms. CONCLUSION A careful and thorough history and examination, and targeted investigation, of the patient with nasal crusting will ensure correct diagnosis and treatment of patients with this common condition.
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18
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Nasal tuberculosis--an update of current clinical and laboratory investigation. The Journal of Laryngology & Otology 2010; 125:210-3. [PMID: 20955638 DOI: 10.1017/s0022215110002136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report a case of primary nasal tuberculosis, and to discuss the diagnostic difficulties encountered. SETTING A teaching hospital in Norwich, UK. METHOD Case report and review of the English language literature concerning tuberculosis affecting the head and neck region. RESULT The diagnosis of nasal tuberculosis is based on: histological identification of granulomatous inflammation; positive testing for acid-alcohol resistant bacilli; and positive culture. Newer diagnostic tests have the advantage of speed and improved accuracy, but are not as yet completely evaluated for the diagnosis of extra-pulmonary tuberculosis. CONCLUSION It is important to consider nasal tuberculosis in the initial differential diagnosis. The quest to exclude a malignancy may lead to unacceptable delays in treatment.
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Abstract
Inflammatory diseases of the nose and paranasal sinus are commonly encountered in diagnostic histopathology. This review describes the possible manifestations of the common diseases as well as highlighting some of the uncommon causes of sinonasal inflammation which may have importance for treatment and prognosis. The diagnosis of fungal sinusitis is primarily histological. It is important to distinguish between invasive and non-invasive fungal sinusitis, the latter including allergic fungal sinusitis characterized by 'allergic mucin' and scanty fungal hyphae. Nasal eosinophilia is a feature of both allergic and non-allergic rhinosinusitis and a wide range of secondary changes in inflammatory polyps may lead to diagnostic confusion. Nasal biopsies are often taken from perforations or inflammatory masses to confirm or exclude granulomatous diseases. There is a broad differential diagnosis for granulomatous sinonasal disease and pathologists should appreciate the diagnostic histological and clinical features of these conditions.
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Affiliation(s)
- Tim Helliwell
- is a Reader in the Division of Pathology, University of Liverpool, Liverpool, UK. Conflicts of interest: none
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20
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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