TITLE:
Refractory Otitis Media as an Early Manifestation of Systemic Tuberculosis: A Case-Based Diagnostic Approach
AUTHORS:
Isabella Mesa-Beltran, Paula Dúran-Gallardo, Daniela Peñaloza-Barrios, Natalia Macias-Arrazola, Carlos Vásquez-Hernández, Jhonatan Macias-Alvarado, Mariana Turizo-Terán, Maria Isabel Nuñez-Donado, Lina Peréz-Villa
KEYWORDS:
Tuberculosis, Pulmonary, Otitis Media, Hearing Loss, Conductive, Mycobacterium tuberculosis
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.9,
September
14,
2026
ABSTRACT: Background: Refractory otitis media represents a frequent yet challenging scenario in clinical practice, particularly when standard antimicrobial therapy fails. Although most cases are attributed to chronic inflammatory or infectious conditions, a subset may reflect underlying systemic disease. Tuberculous otitis media (TOM) is an uncommon but clinically significant entity, often underrecognized due to its atypical presentation and low diagnostic yield of local testing. This study aims to highlight a structured diagnostic approach to refractory otitis media, emphasizing the role of systemic evaluation. Case Presentation: We report the case of a 35-year-old man with a 6-month history of persistent otorrhea, aural fullness, and conductive hearing loss unresponsive to prolonged antibiotic therapy. Otoscopic examination revealed a thickened and retracted tympanic membrane without perforation, and temporal bone computed tomography showed soft tissue density in the middle ear and mastoid without bony erosion. Initial microbiological and histopathological analyses of middle ear specimens were inconclusive. Given the discordance between clinical evolution and local findings, a stepwise diagnostic reassessment was undertaken, including systemic evaluation. Chest imaging revealed findings suggestive of active pulmonary tuberculosis, and diagnosis was confirmed by polymerase chain reaction for Mycobacterium tuberculosis from bronchoalveolar lavage fluid. Anti-tuberculosis therapy was initiated, resulting in progressive clinical, endoscopic, and audiometric improvement, with complete resolution and no recurrence at 18 months. Discussion: This case underscores key diagnostic pitfalls in refractory otitis media, including overreliance on local testing and delayed consideration of systemic etiologies. Based on this experience and available literature, we propose a practical diagnostic framework incorporating clinical red flags, limitations of local microbiological studies, and indications for systemic screening. Early identification of TOM can prevent unnecessary surgical interventions and allow effective medical management. Conclusion: Refractory otitis media with atypical features should prompt a structured diagnostic approach that extends beyond the ear. Incorporating systemic evaluation into clinical decision-making is essential for timely diagnosis of tuberculous otitis media and for avoiding misdiagnosis and overtreatment.