1,3,4,9 It classically affects children more often than adults. Middle ear tuberculosis as a primary site is rare. REVIEW OF THE LITERATURE AND THE DIFFERENTIAL DIAGNOSIS The purpose of this paper was to review the literature on this theme, to report four cases of tuberculous otitis media, and to describe the predisposing factors, clinical features, the diagnosis, the progression, and therapy. This is due to lack of constitutional symptoms and the fact that signs and symptoms are frequently indistinguishable from non-tuberculous chronic otitis media. 4 This decreased incidence has meant that tuberculous otitis media is currently misdiagnosed, particularly in underdeveloped countries. 8,9 Its current frequency in developed countries ranges from 0.05 to 0.9% of the causes of chronic middle ear infection. In the beginning of the 20th century, tuberculosis caused 3% to 5% of chronic suppurative otitis media cases this rate decreased with the advent of anti-tuberculosis therapy. In the head and neck tuberculosis affects mostly the larynx, and to a lesser degree, the middle and external ear, the tonsils, neck lymph nodes, the pharynx, the mouth and salivary glands. 3įactors that have led to an increased incidence of tuberculosis in past decades include: the increased prevalence of HIV infection an increased incidence of people living in poor social and economic conditions increased resistance to anti-tuberculosis therapy the development of resistant bacilli drug dependency diabetes and alcoholism. 2 A complicating factor in this disease, other than malnutrition, is the high treatment abandonment rate, making therapy successful in only 65% of cases this situation merely disseminates contamination. Certain Brazilian municipalities have even higher incidence rates, such as 210/100,000 (Cedro, PE), 100/100,000 (Manaus, AM) and 160/100,000 (Rio de Janeiro, RJ). 1 Brazil is tenth worldwide in the incidence of tuberculosis, and the first in number of cases per year in the Americas the disease affects 55/100,000 inhabitants, particularly in major urban centers. It forms granulomas with caseous necrosis due to the cell response of involved tissues. This is not to say we cannot have a virus that affects the inner ear.Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis, a slow-growing strict aerobic bacillus. But ask anyone with Meniere’s and they will tell you that it is not a condition that can be easily dealt with. The links describe Meniere’s and some treatments available at this time. What happens when they malfunction? Bad things such as Meniere’s Disease, or endolymphatic hydrops, is the most common. When the fluid levels of the perilymph and endolymph are at an equillibrium, you have regular hearing and balance functioning so you hear well and are not dizzy! The endolymph fluid is the opposite, high in potassium and low in sodium which gives it a positive charge. This is very similar to the cerbrospinal fluid surrounding the brain and spinal column. As I stated earlier, the perilymph fluid is high in sodium and low in potassium with basically a negative charge. The perilymph and endolymph fluids are separated by a membrane called the membranous labyrinth. The second fluid in the inner ear is called the endolymph. Remember this, as it becomes important later. If you recall from high school chemistry or biology (I can’t remember that far back!), there is a sodium/potassium pump that keeps the levels where they should be. The perilymph is high in sodium and lower in potassium. The perilymph fluid fills the space inside the bony labyrinth that surrounds the membranous labyrinth. The inner ear is where some of the most interesting things happen, and they happen in fluid. These lie beyond the middle ear where your little bones are- the malleus, incus and stapes (hammer, anvil and stirrup). The labyrinth consists of the semicircular canals (the balance center) and the cochlea (the hearing center). In the inner ear there is both a bony labyrinth and a membranous labyrinth (the green line on the diagram). Last month when I wrote the Barotrauma blog (which has become one of my most popular this year, thank you), I mentioned that I would write about perilymph.
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