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<p>Tuberculosis otitis media (TOM) is an uncommon form of extrapulmonary tuberculosis, constituting less than 1% of chronic suppurative otitis media cases. Its insidious presentation, frequent bacterial co-infection and non-specific features often delay diagnosis and increase the risk of severe intracranial complications. We describe a 16 year old boy with chronic otorrhea, postauricular swelling and hearing loss, unresponsive to antibiotics. Imaging revealed otomastoiditis, multiple cerebral abscesses, meningitis and dural venous sinus thrombosis. Intraoperative findings included sequestra, granulation tissue and cold abscess. Cultures grew <i>Proteus mirabilis</i> and <i>Pseudomonas</i>, while CBNAAT detected <i>Mycobacterium tuberculosis</i> with very low rifampicin sensitivity. The patient underwent modified radical mastoidectomy and received intravenous meropenem and vancomycin, anti-tubercular therapy, steroids and prophylactic phenytoin. This case emphasizes the aggressive potential of TOM with bacterial superinfection, the role of molecular diagnostics and the importance of early multidisciplinary management.</p>

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Intracranial and Vascular Complications of Tuberculous Otitis Media with Secondary Bacterial Infection: A Rare Case Report

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Maran Surya Muthukumaran,
  • Shanjai Krishnan Murugan,
  • Harshinidevi Manivannan,
  • Sai Sri Lasya Kakani

摘要

Tuberculosis otitis media (TOM) is an uncommon form of extrapulmonary tuberculosis, constituting less than 1% of chronic suppurative otitis media cases. Its insidious presentation, frequent bacterial co-infection and non-specific features often delay diagnosis and increase the risk of severe intracranial complications. We describe a 16 year old boy with chronic otorrhea, postauricular swelling and hearing loss, unresponsive to antibiotics. Imaging revealed otomastoiditis, multiple cerebral abscesses, meningitis and dural venous sinus thrombosis. Intraoperative findings included sequestra, granulation tissue and cold abscess. Cultures grew Proteus mirabilis and Pseudomonas, while CBNAAT detected Mycobacterium tuberculosis with very low rifampicin sensitivity. The patient underwent modified radical mastoidectomy and received intravenous meropenem and vancomycin, anti-tubercular therapy, steroids and prophylactic phenytoin. This case emphasizes the aggressive potential of TOM with bacterial superinfection, the role of molecular diagnostics and the importance of early multidisciplinary management.