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Tuberculosis (TB) Mastoiditis: A Case Series at Red Cross Children's Hospital, Cape Town, South Africa

Tuberculosis (TB) is endemic in South Africa. Children have a higher chance of developing Extra-Pulmonary Tuberculosis (EPTB) than adults. We present a case series of four children with TB mastoiditis. Medical folders were reviewed on all 4 cases with confirmed TB positive mastoiditis. All cases were under 5 years old, and presented with features consistent with mastoiditis: post-auricular swelling and displaced pinna, with between 3 and 7 days duration. All cases presented with otorrhoea (Case 1 and 4 central perforation, case 2 polyp from the attic). Case 3 had OME. All cases had no constitutional symptoms of TB. CT of the temporal bones for all demonstrated extensive bony destruction of the mastoid with opacified air cells and demineralised ossicles. Case 1 & 2 had extradural abscesses, case 4 had a subdural collection. Case 1 had a sigmoid sinus thrombus, the posterior rim of petrous bone was eroded in Case 2. Cortical mastoidectomies were performed and post- auricular abscesses drained in all. Tissue was sent for microscopy and histology. Acid Fast Bacilli (AFB) was detected on culture alone. Histology detected caseating granulomatous inflammation suggestive of TB. Audiometry for two cases demonstrated conductive hearing loss, while one had a mixed moderate hearing loss. Drug therapy was initiated in all 4 cases, mean follow up was 6.3 months. Paediatric otolaryngologists should be aware of otogenic TB, particularly in endemic regions. TB mastoiditis, while similar in presentation to typical bacterial mastoiditis, the degree of bony destruction is extensive. The ossicular chain is typically involved and monitoring hearing is necessary.

  • Awareness of TB Mastoiditis in the endemic world
  • Involvement of ossicular chain more common
  • Monitoring hearing is necessary

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Shazia Peer (Author,Co-Author), Division of Otolaryngology, University of Cape Town, shaziapeer@gmail.com;
Paediatric Otolaryngologist, Head - Division of Otolaryngology, Red Cross Children's Hospital, Cape Town

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.

Taseer Din (POC,Primary Presenter,Author), University of Cape Town, Groote Schuur Hospital, taseer_d4@hotmail.com;
Dr Taseer Feroze Din, originally from Nairobi, Kenya, studied his undergraduate at the University of Nairobi, now pursuing his Masters in ENT at the University of Cape Town as a Registrar.
      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.