Synchronous tuberculous involvement of both ears and the larynx in a patient with active pulmonary disease.

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Abstract
Since the incidence of pulmonary tuberculosis in the United States has declined dramatically, this diagnosis is often overlooked in the differential diagnosis of puzzling extra-pulmonary disease. Recent publications emphasize that tuberculosis still needs to be considered in patients with chronic ear, nose, and throat complaints. A patient with tuberculosis involving both middle ears, the larynx, and the lung was correctly diagnosed only after a prolonged delay and several visits for chronically draining ears. As a result of the infection, subtotal bilateral tympanic membrane perforations and a profound hearing loss in both ears occurred. This case emphasized the importance of a high index of suspicion in the evaluation and treatment of patients with symptoms of chronic diseases who fail to respond to conventional therapy.

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