Tuberculous otitis media without lung involvement and the risk of airborne transmission.

Tuberculous otitis media (TOM)/mastoiditis is a rare disease in developed countries. A delayed diagnosis causes significant morbidities including hearing loss, facial palsy, vertigo, and an intracranial invasion. We present a previously healthy 28-year-old woman working as a respiratory therapist. She had suffered from chronic intermittent otorrhea since June 2006, refractory to medical therapy. Illustrated in Fig. 1A, high resolution of computed tomography of the temporal bone in Aug 2006 suggested right otitis media with mastoid involvement. Significant hearing loss and facial palsy complicated in November 2006. She underwent surgical intervention subsequently, which showed total perforation of the right eardrum and whitish granulation tissue over the right middle ear. The pathologic findings revealed necrotic debris and granuloma formation. The mycobacterium culture of debridement was negative. But, the similar symptoms still bothered her, even though she received antibiotics therapy and additional operation in July 2007. The diagnosis of tuberculous otitis media was confirmed by microbiologic evidence of ear discharge approximately 18 months after her initial presentations. Meanwhile, the