16 Specific Infections
Holger Sudhoff, Henning Hildmann
Specific infections are generally not expected before surgery but are diagnosed during the histological evaluation of the specimen. The surgical outcome does not differ in comparison to cases of unspecific infection if sufficient medical treatment is started. Even though tissue removal for histology is not routinely done in most centres, surgeons should be encouraged to take specimens more frequently at least in suspected cases.
Middle ear tuberculosis often has a typical whitish appearance and its gran- ulations have a little tendency to bleed. The multiple perforations of the tym- panic membrane described in some textbooks as being typical for middle ear tuberculosis have not been seen in our material. Biopsies should be sent for histology where typical Langerhans’ cells are found. As cultures may but often do not produce tubercle bacilli, identification by polymerase chain reaction has become of high diagnostic value. Postoperative general examination of the patient mostly shows other manifestations of the tuberculosis. The treatment is generally done by a pulmonologist according to the localizations and the extent of the disease.
Sarcoidosis may also be seen in patients with pulmonary affection. It is extremely rare and can be diagnosed by histological examination. Sarcoidosis should be considered in patients with lung disease.
Actinomycosis of the middle ear has been described in the literature and can also be identified by histological examination.
Wegener’s granulomatosis is a systemic inflammatory condition affecting the nose, kidneys, lungs and other organs.
Chapter16 94
