Tuberculosis in the Head and Neck Region: Experience in the Eastern Tertiary Care Centre of Nepal
Apar Pokharel *
Department of ENT, Christian Medical College, Vellore, India.
Shyam T. Chettri
Department of ENT, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.
Deepak Paudel
Department of Surgery, Christian Medical College, Vellore, India.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Tuberculosis (TB) primarily affects lungs, however extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in head and neck region.
Objective: To study the otorhinolaryngological manifestations of tuberculosis in eastern tertiary care centre of Nepal and its relationship with primary tuberculosis of lung and human immunodeficiency virus infection.
Methods: This is a retrospective study conducted in the Department of Otolaryngology and Head and Neck Surgery in B. P. Koirala Institute of Health Sciences, Nepal. Our study group comprised of 85 patients diagnosed with extrapulmonary manifestations of tuberculosis in the head and neck region from 2012-2014 over the period of 2 years. Records of patients diagnosed and treated for tuberculosis in the head and neck region at our institute for two year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Pulmonary tuberculosis was screened in all patients by doing chest radiography and sputum AFB (Acid Fast Bacillus). HIV (Human Immunodeficiency Virus) screening was also done in all patients.
Results: 85 cases showed extrapulmonary otorhinolaryngological manifestations of tuberculosis. Majority of the cases were male and in the third decade of life. Commonest manifestation was cervical lymphadenopathy. Fine needle aspiration cytology (FNAC), histopathological diagnosis and Acid Fast Bacilli (AFB) staining were used to confirm the diagnosis. All patients were treated with category I anti TB treatment (ATT) in the DOTS (Direct Observed Treatment Shortcourse) clinic which achieved cure in all cases.
Conclusion: Extrapulmonary manifestations of tuberculosis in the head and neck region is a frequent, clinical entity encountered especially in developing countries like Nepal. It should always be kept as one of the differential diagnosis in the pathology of head and neck region. High degree of suspicion is necessary to reach diagnosis. Category I ATT is effective for treatment.
Keywords: Tuberculosis, cervical lymphadenopathy, Acid Fast Bacilli (AFB), Fine Needle Aspiration Cytology (FNAC).