We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.
Tuberculous otitis media (TOM) is rare in developed countries; it accounts for only 0.06% of all cases of suppurative otitis media.1 Although the prevalence of tuberculosis has decreased in South Korea during the past decade, it remains a serious public health problem. In 2007, the incidence of tuberculosis in South Korea was 71.6 per 100,000 population; of these, there were only 4 cases of TOM.2