Nasal Tuberculosis

A review of 280 nasopharyngeal tuberculosis cases and the effectiveness of antituberculosis treatments

Objectives

Nasopharyngeal tuberculosis is a rare form of tuberculosis in which Mycobacterium tuberculosis infects the nasopharyngeal tissue. In this study, we analyzed key clinical features to prevent misdiagnosis and to raise awareness of the condition, while recommending suitable treatments. We also report a case of nasopharyngeal tuberculosis presenting with nasal congestion and intermittent ear fullness, contributing valuable educational insight for diagnosis.

Methods

Demographic and clinical data from patients with nasopharyngeal tuberculosis were collected from PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials up to September 2022. In total, 280 patients from 69 studies were analyzed.

Results

Reports indicate that the incidence of nasopharyngeal tuberculosis has doubled every decade, particularly in Asia. Most patients are female, presenting with granulomatous pathology and findings such as masses, lymphoid hyperplasia, polypoid formations, or swelling on endoscopic examination. Common symptoms include nasal obstruction, hearing impairment, sore throat, and dysphagia, usually accompanied by cervical lymphadenopathy. The mean duration from symptom onset to diagnosis is ∼2.88 months, and the average time from the start of treatment to resolution of symptoms is ∼ 4.90 months. The antituberculosis treatment regimen and duration are significantly associated with the time to resolution (r = -0.648, p = 0.003 and r = 0.584, p = 0.028, respectively).

Conclusion

These results suggest that an extended regimen of antituberculosis drugs may expedite symptom relief. However, there is a need for more standardized data on patient outcomes and treatment efficacy due to the current lack of comprehensive data.

A Rare Case of Tubercular Osteomyelitis of Maxilla: A Case Report

Tuberculosis (TB) is a chronic granulomatous infection which primarily affects lungs. It is caused by Mycobacterium tuberculosis which was discovered by Dr Robert Koch. It can also affect other organs. Tuberculosis is a major cause of morbidity and mortality in developing countries. Early detection and initiation of antitubercular therapy are important in the management of TB. Extrapulmonary TB might not exhibit same features as pulmonary tuberculosis. Tuberculosis of maxilla is an extremely rare entity which can be misdiagnosed as carcinoma of maxillary sinus or other infectious conditions. We are presenting a case of tuberculous osteomyelitis of maxilla in a 14-year-old female who came with a discharging sinus over the right cheek. She underwent endoscopic debridement of sinuses and histopathological examination was suggestive of Koch's infection. Patient was further treated with antitubercular therapy and showed significant improvement at four weeks follow up.

Primary nasal tuberculosis-a rare clinical entity

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.

Eight cases of nasal tuberculosis

OBJECTIVE

To elucidate the clinical characteristics of nasal tuberculosis and to discuss its diagnostic difficulties.

STUDY DESIGN

Retrospective clinical analysis.

RESULTS

A total of eight patients presented with nasal tuberculosis during the study period (from January 1989 through December 2006). Six were female and two were male. The patient age varied from 17 to 51 years, with a mean of 31 years. The most commonly involved site was the nasal septum (7 of 8). Perforation of the nasal septum was observed in three cases. Sinus invasion was observed in two cases and required sinus surgery. Six of the cases were a result of primary infections, while two were secondary disease manifestations. All patients were treated with anti-tuberculosis medications, with subsequent improvement with regard to clinical symptoms and physical signs.

CONCLUSIONS

We present the largest number of nasal tuberculosis cases reported in the medical literature from a single institute. Diagnosing nasal tuberculosis requires a high index of suspicion and occasionally the use of experimental drug treatment options.

Multifocal Tuberculosis of the Nose and Lymph Nodes without Pulmonary Involvement: A Case Report

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.

Primary Nasal Tuberculosis: A Case Report

During the past 2 decades, tuberculosis—both pulmonary and extrapulmonary—has re-emerged as a major health problem worldwide. Nasal tuberculosis—either primary or secondary to pulmonary tuberculosis or facial lupus—is rare, but it should be considered in the differential diagnosis of nasal granulomas. We describe a case of primary nasal tuberculosis in an adult male who presented with a polypoid lesion in one nasal cavity. The diagnosis was based on histopathology and the patient's successful response to antituberculous drug treatment. Given the rising incidence of tuberculosis, it is prudent that otolaryngologists remain cognizant of this infection as a potential cause of unusual lesions in the head and neck.

An Unusual Case of Primary Nasal Tuberculosis with Epistaxis and Epilepsy

Primary nasal tuberculosis is rare. We report a case that was all the more extraordinary because of the age and sex of the patient (an 11-year-old boy), the unusual associated symptoms (epistaxis and grand mal seizures), and the presence of intracranial extension. Clinical and radiologic finding s on our initial evaluation suggested that the patient had a large sinonasal malignancy. The patient manifested no evidence of pulmonary tuberculosis. The diagnosis of primary nasal tuberculosis was established only after we obtained the results of histopathology of the excised mass and a subsequent tuberculin skin test; the diagnosis was confirmed by the patient's rapid response to antituberculosis drug therapy. We also review the relevant literature on this rare condition.