Since the discovery of the subcutaneous node bacillus in 1882, middle ear subcutaneous node could be accurately diagnosed. It often occurs secondary to pulmonary subcutaneous node disease, with an incidence rate of 13% in the early 19th century. Over the past two decades, due to the development of effective anti-tuberculosis drugs, the incidence of pulmonary subcutaneous node has significantly decreased, and subcutaneous node otomastoiditis is now rarely seen. The largest domestic report was by Wang Pengwan in 1956, documenting 41 cases.

bubble_chart Etiology

Similar to general suppurative otitis media, bacterial-containing secretions enter the middle ear through the Eustachian tube. Occasionally, foxtail millet granulomatous pulmonary subcutaneous nodules can infect the middle ear via hematogenous spread. Newborns may contract bovine subcutaneous nodule bacilli by consuming improperly sterilized milk.

bubble_chart Clinical Manifestations

In cases of severe pulmonary subcutaneous nodules with cavitation, painless water from the river is found in the ear, which later becomes infected and turns into thick pus. Early symptoms rarely include tinnitus or deafness. The tympanic membrane appears grayish-white and edematous, with erosions and necrosis in the tense portion, presenting multiple small perforations that later coalesce into a large perforation. The flaccid portion is rarely affected, differing from typical suppurative otitis media. Prolonged pus discharge leads to ossicular necrosis, rapid hearing loss, and frequent occurrences of deviation of the mouth and postauricular fistula. The incidence of deviation of the mouth accounts for 20%, particularly common in children, which is a characteristic feature of subcutaneous nodule otitis media. Intracranial complications are relatively rare, though subcutaneous nodule meningitis may occasionally occur.

History of subcutaneous nodules in the lungs, positive subcutaneous nodule bacillus test in children, and subcutaneous nodule bacilli detected in ear secretions.

bubble_chart Treatment Measures

Systemic treatment with antituberculous drugs such as streptomycin, isoniazid, PAS, and rifampicin is administered. Locally, the ear canal is cleaned with hydrogen peroxide, followed by the application of 5% streptomycin or 0.1% rifampicin solution. Tympanic membrane repair should not be performed until the systemic condition improves. For chronic mastoiditis with bone destruction, postauricular fistula, and deviation of the mouth, a radical mastoidectomy should be promptly performed, and skin grafting in the surgical cavity is not recommended.