ScienceDirect
www.elsevier.com/locate/amjoto
Case reports
A BS TRACT
Article history:
Eustachian tube (ET) dysfunction may cause pathological changes in the middle ear,
including recurrent acute otitis media and otitis media with effusion (OME). Mechanical
obstruction of the ET may be caused by primary tumor-like lesions arising from ET or
secondary ET infiltration due to nasopharyngeal and parapharyngeal space tumor.
Tuberculosis is known to affect almost every organ in the body, and it should be a
concern of each and every medical practitioner. However, tuberculosis of the ET has not
been reported in the literature previously. This article reports primary tuberculosis arising
in the ET that presented as aural fullness and hearing disturbance in a patient with OME.
2015 Elsevier Inc. All rights reserved.
1.
Introduction
The eustachian tube (ET) is a short but complex hourglassshaped structure which connects the nasopharynx with the
middle ear cavity. Therefore, ET may be deeply associated
with otologic and rhinologic symptoms. It is well known that
ET dysfunction or occlusion is an important factor leading to
otitis media with effusion (OME) [1]. Although ET dysfunction
may be triggered by many causes, including viral infection,
chronic sinusitis, allergic rhinitis, adenoid hypertrophy, and
cleft palate [2], mechanical obstruction of the ET should be
considered. Tuberculosis is known to affect almost every
organ in the body, but tuberculosis of the ET has not been
reported in the literature, to the best of our knowledge. Herein
we describe this rare clinical presentation of primary tuberculosis arising in the ET associated with OME. This study was
approved by the institutional review board of Pusan National
University Hospital.
2.
Case report
Corresponding author at: Department of Otorhinolaryngology, Pusan National University School of Medicine, Pusan National University
Hospital, 179 Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea. Tel.: + 82 51 240 7824; fax: +82 51 246 8668.
E-mail address: choks@pusan.ac.kr (K.-S. Cho).
http://dx.doi.org/10.1016/j.amjoto.2015.04.004
0196-0709/ 2015 Elsevier Inc. All rights reserved.
576
Fig. 1 Otoscopic examination and pure tone audiometry (PTA). (A) Otoscopy shows thick and glue-like fluid collection in the
middle ear cavity. (B) PTA shows left conductive hearing loss.
3.
Discussion
Fig. 2 Nasal endoscopy and computed tomography (CT) findings of eustachian tube (ET) tuberculosis. (A) Nasal endoscopy
reveals the necrotic lesion around the ET orifice. (B) A CT scan of the paranasal sinus shows an asymmetric thickening of the
left Rosenmullers fossa with obliteration of the left parapharyngeal space.
577
Fig. 3 Histopathologic findings of Eustachian tube mass. (A) Microscopic finding shows extensive caseous necrosis rimmed by
mixed inflammatory cells and some epithelioid cells (H&E stain, 400). (B) Acid-fast bacillus stain reveals acid-fast, pink-colored
bacilli against the sea of necrosis (ZiehlNeelsen stain, 1000).
4.
Conclusion
REFERENCES