# Tuberculosis in ENT

> Tuberculosis in ENT for MBBS ENT: scrofula neck nodes, laryngeal and aural TB, CBNAAT diagnosis and NTEP treatment regimens.

- Canonical URL: https://prepelephant.com/topics/mbbs/ent/tb-ent
- Exam / course: MBBS · Subject: ENT
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Tuberculosis in ENT", PrepElephant, https://prepelephant.com/topics/mbbs/ent/tb-ent

## Direct answer

Tuberculosis involves the head and neck more often than any other extrapulmonary territory, and cervical lymphadenitis — scrofula — leads the list: painless matted posterior-triangle nodes progressing to cold abscess and, untreated, a collar-stud sinus. Laryngeal tuberculosis presents with hoarseness from a granular or ulcerated larynx that can mimic carcinoma, classically posterior; tuberculous otitis media is painless otorrhoea with multiple perforations, pale granulations and early facial palsy. Fine-needle aspiration or biopsy with cartridge-based nucleic acid amplification testing (CBNAAT/TrueNat under India's National TB Elimination Programme) delivers diagnosis and rifampicin sensitivity within hours; treatment is antitubercular therapy, with surgery reserved for drainage and diagnostic tissue.

## What you must remember

- **Cervical lymphadenitis:** painless firm nodes matting into groups (level V favoured), progressing through caseation to a fluctuant cold abscess, then a collar-stud abscess and discharging sinus — the physical sign most written in Indian practicals.
- **Laryngeal TB:** hoarseness with posterior glottis and arytenoid granular or ulcerative change in cavitary lung disease; modern lesions may involve the anterior glottis and mimic carcinoma, so biopsy is mandatory.
- **Tuberculous otitis media:** painless chronic otorrhoea with multiple perforations, pale, pale granulations early facial nerve palsy (compared with ordinary CSOM), and hearing loss out of proportion; culture-confirmation on aural discharge or biopsy tissue completes the diagnosis.
- **Other sites:** pharyngeal ulcers, retropharyngeal cold abscess, lupus vulgaris of facial skin, tuberculosis of the temporal bone, and tuberculous meningitis with cranial nerve palsies.
- **Diagnostic ladder as practised in India:** fine-needle aspiration cytology or biopsy showing caseating granulomas, then CBNAAT (GeneXpert) or TrueNat on the same sample for Mycobacterium tuberculosis and rifampicin resistance within hours — liquid culture remaining the reference standard; sputum and chest imaging accompany, as pulmonary disease changes the public-health pathway.
- **Treatment per NTEP:** daily therapy under direct observation — two months of isoniazid, rifampicin, pyrazinamide and ethambutol, then four months of continuation therapy per current NTEP guidance; corticosteroids for laryngeal oedema; drug-resistant disease follows NTEP regimens after sensitivity testing.
- **Surgical role:** aspiration of cold abscess through healthy skin, excision biopsy where diagnosis is in doubt, and closure of healed sinuses — excision never replaces chemotherapy.
- **The Indian weight of the topic:** India carries the world's largest TB burden, so every chronic neck node, non-healing oral ulcer and atypical chronic otitis media is investigated with TB on the differential — the clinical reflex the exam expects you to articulate.

## From node to diagnosis in a district hospital

A 26-year-old woman has a three-month painless right neck lump: matted level V nodes, non-tender, with evening fevers and weight loss. Fine-needle aspiration returns caseating granulomas, and CBNAAT on the aspirate detects Mycobacterium tuberculosis with rifampicin sensitivity the same day.

She is registered under NTEP and started on daily therapy; the nodes shrink over two months without drainage. Had she presented later with a fluctuant swelling: aspiration through healthy skin, or excision biopsy if diagnosis were in doubt — but chemotherapy remains the definitive treatment. Now substitute a 55-year-old smoker with hoarseness and an ulcerated cord lesion that looks like carcinoma: biopsy granulomas with CBNAAT positivity confirm laryngeal tuberculosis, and therapy restores the voice. In India, tissue answers before assumption, and every specimen travels with a TB test.

## Where examiners dig

The first question is the cold abscess: what is it, and how is it drained? A caseating, non-inflamed abscess of tuberculous origin, drained by aspiration through healthy skin away from the adherent site precisely to avoid a chronic sinus — the technical detail that separates a pass answer from a good one. The second is the collar-stud abscess: the tuberculous abscess erodes between two layers of deep cervical fascia and presents as a dumbbell configuration, a standard short-note diagram. Third, tuberculous versus ordinary chronic suppurative otitis media: painless, pale, multiple perforations, disproportionate hearing loss and early facial palsy favour tuberculosis. And examiners expect national programme vocabulary — CBNAAT, TrueNat, daily therapy under NTEP — not a generic "ATT for 6 months".

## Frequently asked questions

### What is scrofula and how does it evolve?

Tuberculous cervical lymphadenitis — painless matted nodes progressing to caseation, cold abscess, collar-stud configuration and, untreated, a discharging sinus over the neck.

### How does tuberculous otitis media differ from ordinary CSOM?

It is typically painless with pale granulations and multiple perforations, hearing loss out of proportion, and a notable tendency to early facial nerve palsy.

### Which rapid test confirms tuberculous lymphadenitis in India?

Cartridge-based nucleic acid amplification testing (CBNAAT, GeneXpert) or TrueNat on aspirate or biopsy tissue, detecting Mycobacterium tuberculosis and rifampicin resistance within hours under NTEP.

### How is laryngeal tuberculosis treated?

With antitubercular therapy under NTEP — two months of four drugs followed by a continuation phase; corticosteroids may be added for laryngeal oedema.

### Why is a cold abscess aspirated through healthy skin?

To avoid traversing the adherent, thinned skin over the abscess, which would seed the tract and create a persistent tuberculous sinus — aspiration at a distance, or excision, protects the skin.