Study note
ENTCholesteatoma and Chronic Otitis Media

Tubercular otitis media: pathological progression

THE CONTEXT
The pathological process is slow and insidious, involving the middle ear mucosa, tympanic membrane and potentially bone.

Mucosal and tympanic membrane changes

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Tubercles develop in the submucosal layers of the middle ear cleft and undergo caseation.
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Painless necrosis of the tympanic membrane occurs.
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Multiple perforations may develop and coalesce into a single large perforation.
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The middle ear and mastoid become filled with pale granulations.

Bone involvement and complications

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Caries of bone and ossicles may occur and lead to complications.
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Mastoiditis, facial paralysis, postauricular fistula and profound hearing loss are often seen.
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Osteomyelitis may occur with formation of bony sequestra.
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