Tuberculosis affects all parts of the body, although some more commonly than the others. Pulmonary tuberculosis is the most common type of tuberculosis accounting for approximately 80% of the tuberculosis cases.
ENT-Related Tuberculosis is one of the rarer forms of extra pulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. Scrofula is the Latin word for brood sow, and it is the term applied to tuberculosis of the neck. Cervical tuberculosis is usually a result of an infection in the lymph nodes, known as lymphadenitis.
Other TB manifestations are laryngeal TB, Tonsillar and oral cavity TB, Middle ear and Mastoid TB and Nose and sinus TB.
Cervical lymph Node Tuberculosis
Cervical TB Lymphadenitis manifests as unilateral or bilateral enlargement of cervical lymph nodes, frequent in supraclavicular region, namely, anterior and posterior of sternocleidomastoid muscle under the lower jaw. In early stage or initial period, the swollen lymph nodes are hardened, painless and moveable. It will then progress to inflammation around lymph nodes, causing adhesion of lymph nodes and surrounding skin, lymph nodes may chained and merged together forming immovable clusters. In late stage, the lymph nodes will undergo caseous necrosis, liquefaction and form cold abscess.
The decomposition of cold abscess will yield white granulated pus which later develops into unhealed fistula or chronic ulcer; skin of ulcer s edge is dark red and slink while granulations tissues are pale (white) and have edema. After increase of patient s immunity and proper treatment, those pathological changes of lymph nodes will stop and undergo calcification. Some patients may have sub febrile temperature, excessive sweating, loss of appetite, cachexia and other general intoxication symptoms.
If there is enlargement of cervical lymph nodes but without cold abscess, it will be difficult to diagnose, therefore, it must be differentiated from chronic lymphadenitis, lymphosarcoma, tumor metastases to neck and so on. If the differential diagnosis is difficult, biopsy may be necessary.
Treatment:
General treatment: Rational diet and rest.
Poly Chemotherapy:The initial therapy was started with a combination of isoniazid (5 mg/kg), rifampicin (10 mg/kg), and pyrazinamide (15 to 20 mg/kg),
When significant side effects occurred, the drug responsible for these effects was replaced by ethambutol (25 mg/kg).The duration of treatment recommended at the patient\’s discharge from the hospital ranged between 6 and 12 months.
Prevention: hygiene education, cultivate the habit of not spitting phlegm anywhere, BCG vaccination for children, care of oral hygiene, early treatment of dental caries and resect pathological tonsils.
