In simple words: Tuberculosis (TB) can affect the inner or middle ear. This is rare and happens when TB bacteria becomes active again after an initial infection. Symptoms include ear discharge, problems with the eardrum, hearing loss, facial paralysis, and swollen neck glands.Other TB symptoms, like fever and weight loss, may also be present.

Tuberculosis (TB) of the inner or middle ear is a rare manifestation of extrapulmonary tuberculosis resulting from reactivation of the bacilli lodged in the area from an original infection by Mycobacterium tuberculosis and rarely by Mycobacterium bovis or by direct introduction of the bacteria through the Eustachian tube. A patient with TB of the inner or middle ear can experience symptoms similar to suppurative otitis media, that is, painless ear discharge (otorrhea), tympanic membrane (eardrum) perforations, hearing loss, facial nerve paralysis, and swollen or enlarged lymph nodes (lymphadenopathy) in the neck as well as other typical symptoms of TB such as fever and weight loss. Diagnosis is based on blood tests, tuberculin skin test, and previous history of tuberculosis or active disease. CT scan may show opacification of the middle ear. Definitive diagnosis is made by culture results and histological analysis for acid–fast bacilli. Treatment includes antituberculous chemotherapy with isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol. Other drugs may be tried if these are ineffective. In severe cases of bony sequestration, surgical therapy is indicated.

Example 1: A patient presents with painless ear discharge, hearing loss, and swollen lymph nodes in the neck. They also report fever and weight loss. A tuberculin skin test is positive, and A18.6 is used for Tuberculous otitis media., A patient with a history of TB presents with facial nerve paralysis and ear discharge. A CT scan reveals opacification of the middle ear. Cultures are positive for Mycobacterium tuberculosis, confirming the diagnosis of TB of the middle ear (A18.6)., A child with a history of contact with a person with active TB presents with ear pain and discharge.After diagnostic testing, including a positive culture for Mycobacterium tuberculosis, the diagnosis of TB of the middle ear is confirmed (A18.6).

Documentation should include evidence of active tuberculosis, such as positive cultures, histological findings, or clinical findings consistent with TB in the middle or inner ear.Symptoms, physical exam findings, diagnostic test results, and treatment plans should be clearly documented.