Tuberculosis in the Head and Neck: Changing Trends and Age-Related Patterns
Open accessAbstract
OBJECTIVE: To evaluate changing trends in patient collectives, age-related patterns of manifestation, and diagnostic pathways of patients with extrapulmonary head and neck tuberculosis (TB), and to provide strategies to fasten diagnosis in these patients. STUDY DESIGN: Case control study. METHODS: A 10-year retrospective analysis of 35 patients diagnosed with extrapulmonary TB in the head and neck at a tertiary university institution from 2009 to 2019, with special focus on the influence of the patient's age on consideration of TB and clinical patterns. RESULTS: The vast majority of patients younger than 40 years had their origin in countries with high TB burden (P = .0003), and TB was considered very early as a differential diagnosis (P = .0068), while most patients older than 40 years were domestic citizens initially suspected for a malignancy, who more often had an underlying immunosuppressive condition (0.0472). Most frequent manifestations in both groups were the lymph nodes, larynx, and oropharynx. Surprisingly, no differences in the rates of open TB or history of TB infection in the family anamnesis were found. CONCLUSION: The two groups of patients found most often are younger patients migrating from regions with high TB burden and elderly domestic patients suffering from immunosuppressive conditions, with the latter often being misdiagnosed as malignancies. TB remains an important but difficult differential diagnosis, due to the initially unspecific symptoms and the great variety in the presentation of manifestations in the head and neck. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2701-2705, 2021.
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All our patients moved into dense urban areas from low-density rural areas 5 to 7 years previous to diagnosis.
“all our patients moved into dense urban areas from low-density rural areas 5 to 7 years previous to diagnosis [28].”
From Head and Neck Tuberculosis: A Rare Diagnosis and the Role of Surgical Biopsy and Histopathological Evaluation in Extrapulmonary Disease (2025) · cites this paper as [28]
The Results report migration from high-TB-burden countries among some patients, not all patients. Neither the Results nor the Discussion identifies a move from rural to dense urban areas or gives a 5–7-year interval before diagnosis (pages unavailable in our copy). (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn some studies, TB of the head and neck was found in patients with a history of migration to and from high TB burden areas or in those with immunosuppressive conditions.
“In some studies, TB of the head and neck was found in patients with a history of migration to and from high TB burden areas or in those with immunosuppressive conditions [28]”
From Head and Neck Tuberculosis: A Rare Diagnosis and the Role of Surgical Biopsy and Histopathological Evaluation in Extrapulmonary Disease (2025) · cites this paper as [28]
The Results report that 15 younger patients had migrated from countries with a high TB burden, and the Conclusion identifies an older group with immunosuppressive conditions. These passages support migration from high-burden areas and immunosuppression, but do not establish migration to high-burden areas. (LLM, conf=0.83)
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Cites
Global tuberculosis report (2014)
Gabbasova, L. A., & Who, E. R. E. (2014) · Cited by 12,702 · see citing works
Small, P. M., Hopewell, P. C., Singh, S. P., Paz, A., Parsonnet, J., Ruston, D. C., Schecter, G. F., Daley, C. L., & Schoolnik, G. K. (1994) · New England Journal of Medicine · doi:10.1056/nejm199406163302402 · Cited by 1,110 · see citing works
Dheda, K. U. J., Barry, C. E., & Maartens, G. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00151-8 · Cited by 615 · see citing works
Sester, M., Sotgiu, G., Lange, C. G., Giehl, C., Girardi, E., Migliori, G. B., Bossink, A. W. J., Dheda, K. U. J., Diel, R., Domínguez, J., et al. (2010) · European Respiratory Journal · doi:10.1183/09031936.00114810 · Cited by 535 · see citing works
Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011
Sandgren, A., Hollo, V., & van der Werf, M. J. (2013) · Eurosurveillance · doi:10.2807/ese.18.12.20431-en · Cited by 234 · see citing works
Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011
Solovič, I., Jonsson, J., Korzeniewska-Koseła, M., Chiotan, D. I., Pace-Asciak, A., Slump, E., Rumetshofer, R., Abubakar, I., Kos, S., Svetina-Sorli, P., et al. (2013) · Eurosurveillance · doi:10.2807/ese.18.12.20432-en · Cited by 164 · see citing works
Extrapulmonary tuberculosis: are statistical reports accurate?
Kulchavenya, E. (2014) · Therapeutic Advances in Infectious Disease · doi:10.1177/2049936114528173 · Cited by 152 · see citing works
Tuberculosis in the head and neck: experience in India
Prasad, K. C., Sreedharan, S., Chakravarthy, Y., & Prasad, S. C. (2007) · The Journal of Laryngology & Otology · doi:10.1017/s0022215107006913 · Cited by 122 · see citing works
Meta-Analysis: The Association Between HIV Infection and Extrapulmonary Tuberculosis
Naing, C. M., Mak, J. W., Maung, M., Wong, S. F., & Kassim, A. I. B. M. (2012) · Lung · doi:10.1007/s00408-012-9440-6 · Cited by 116 · see citing works
Mycobacterial Infection of the Head and Neck: Presentation and Diagnosis
Al-Serhani, A. (2001) · The Laryngoscope · doi:10.1097/00005537-200111000-00027 · Cited by 98 · see citing works
Menon, K., Bem, C., Gouldesbrough, D., & Strachan, D. R. (2007) · The Journal of Laryngology & Otology · doi:10.1017/s0022215106002507 · Cited by 95 · see citing works
Sandgren, A., Schepisi, M. S., Sotgiu, G., Huitric, E., Migliori, G. B., Manissero, D., van der Werf, M. J., & Girardi, E. (2013) · European Respiratory Journal · doi:10.1183/09031936.00117213 · Cited by 79 · see citing works
Fine Needle Aspiration Diagnosis of Mycobacterial Lymphadenitis
Ellison, E., Lapuerta, P., & Martin, S. E. (1999) · Acta Cytologica · doi:10.1159/000330969 · Cited by 77 · see citing works
Tuberculosis in the head and neck — a forgotten differential diagnosis
Vaid, S., Lee, Y. Y. P., Rawat, S., Luthra, A., Shah, D., & Ahuja, A. T. (2009) · Clinical Radiology · doi:10.1016/j.crad.2009.09.004 · Cited by 66 · see citing works
Tuberculosis of the head and neck—Epidemiological and clinical presentation
Bruzgielewicz, A., Rzepakowska, A., Osuch-Wójcikewicz, E., Niemczyk, K., & Chmielewski, R. (2014) · Archives of Medical Science · doi:10.5114/aoms.2013.34637 · Cited by 63 · see citing works
A review of 23 patients with tuberculosis of the head and neck
Penfold, C. N., & Penfold, C. N. (1996) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/s0266-4356(96)90246-6 · Cited by 54 · see citing works
Mycobacterial cervical lymphadenitis: A persistent diagnostic problem
Alleva, M., Guida, R. A., Romo, T., & Kimmelman, C. P. (1988) · The Laryngoscope · doi:10.1288/00005537-198808000-00013 · Cited by 53 · see citing works
Orofacial Tuberculosis—A 16-Year Experience With 46 Cases
Andrade, N. N., & Mhatre, T. S. (2011) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2011.07.020 · Cited by 50 · see citing works
Cancer incidence attributable to tuberculosis in 2015: global, regional, and national estimates
Leung, C. Y., Huang, H.-L., Rahman, M. M., Nomura, S., Abe, S. K., Saito, E., & Shibuya, K. (2020) · BMC Cancer · doi:10.1186/s12885-020-06891-5 · Cited by 50 · see citing works
Pang, P., Duan, W., Liu, S., Bai, S., Ma, Y., Li, R., Liu, F., & Sun, C. (2018) · Emerging Microbes & Infections · doi:10.1038/s41426-017-0008-7 · Cited by 46 · see citing works
Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma
Sheikh, S., Pallagatti, S., Gupta, D., & Mittal, A. (2012) · Dentomaxillofacial Radiology · doi:10.1259/dmfr/56238546 · Cited by 43 · see citing works
Head and Neck Tuberculosis: Scenario in a Tertiary Care Hospital of North Eastern India
Das, S. (2016) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2016/17171.7076 · Cited by 39 · see citing works
Srivanitchapoom, C., & Sittitrai, P. (2016) · International Journal of Otolaryngology · doi:10.1155/2016/4817429 · Cited by 38 · see citing works
Heuvelings, C. C., Greve, P. F., de Vries, S. G., Visser, B. J., Bélard, S., Janssen, S., Cremers, A. L., Spijker, R., Shaw, E. J., Hill, R. A., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019642 · Cited by 34 · see citing works
Nasal tuberculosis – an update of current clinical and laboratory investigation
Masterson, L. M., Srouji, I. A., Kent, R., & Bath, A. P. (2010) · The Journal of Laryngology & Otology · doi:10.1017/s0022215110002136 · Cited by 30 · see citing works
Abdissa, K., Tadesse, M., Bezabih, M., Bekele, A., Apers, L., Rigouts, L., & Abebe, G. (2014) · BMC Infectious Diseases · doi:10.1186/s12879-014-0720-z · Cited by 27 · see citing works
Diagnosis of tuberculosis in the head and neck
McAllister, K., & MacGregor, F. B. (2011) · The Journal of Laryngology & Otology · doi:10.1017/s0022215110002732 · Cited by 26 · see citing works
Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience
Oishi, M., Okamoto, S., Teranishi, Y., Yokota, C., Takano, S., & Iguchi, H. (2015) · International Archives of Otorhinolaryngology · doi:10.1055/s-0035-1565011 · Cited by 22 · see citing works
Tuberculous neck lymphadenopathy: A diagnostic challenge
Brucoli, M., Borello, G., Boffano, P., & Benech, A. (2018) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2018.11.012 · Cited by 13 · see citing works
Middle east tuberculosis in an immunocompromised patient: Case report and review of the literature
Velepic, M. M., Vukelić, J., Dvojkovic, Z., Škrobonja, I., & Braut, T. (2020) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2020.10.011 · Cited by 12 · see citing works
Risk Factors for Tuberculosis among HIV-infected Patients Receiving Antiretroviral Treatment
Lawn, S. D., Badri, M., & Wood, R. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.172.10.1348 · Cited by 11 · see citing works
Tuberculosis of the Oral Cavity Affecting Alveolus: A Case Report
Kumar, B. (2011) · Case Reports in Dentistry · doi:10.1155/2011/945159 · Cited by 10 · see citing works
A Clinic-Epidemiological Study of Head and Neck Tuberculosis—A Single-Center Experience
Pajor, A. M., Józefowicz-Korczyńska, M., Korzeniewska-Koseła, M., & Kwiatkowska, S. (2016) · Advances in respiratory medicine · doi:10.5603/arm.2016.0042 · Cited by 10 · see citing works
Diagnosis of laryngeal tuberculosis in a high TB burden area
Matimba, A., Moncho, M., Musoke, J., & Seedat, R. Y. (2020) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-020-05976-y · Cited by 8 · see citing works
Suppurative Cervical Tuberculous Lymphadenitis Mimicking a Metastatic Neck Mass
Bozan, N., Sakin, Y. F., Parlak, M., & Bozkuş, F. (2016) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000002870 · Cited by 7 · see citing works
A rare case of chronic otitis externa due to Mycobacterium tuberculosis
DeSimone, D. C., Heaton, P. R., Neff, B. A., Dao, L. N., Wengenack, N. L., & Fadel, H. J. (2017) · Journal of Clinical Tuberculosis and Other Mycobacterial Diseases · doi:10.1016/j.jctube.2017.05.001 · Cited by 7 · see citing works
Cytoponction ganglionnaire cervicale : facteurs influençant le taux d’échec
Rammeh, S., Rejeb, H. B., Mfarrej, M. K., Znaidi, N. S., Farah, F., Ferjaoui, M., & Zermani, R. (2014) · Revue de Stomatologie de Chirurgie Maxillo-faciale et de Chirurgie Orale · doi:10.1016/j.revsto.2014.02.002 · Cited by 6 · see citing works
Rare Case of Pulmonary Tuberculosis with Hematogenous Spread to Larynx and Skin.
Olteanu, M., Mr, P., Niţu, M., Calarasu, C., Av, M., & Olteanu, M. (2016) · Europe PMC (PubMed Central) · doi:10.12865/chsj.42.02.15 · Cited by 2 · see citing works
Flagged first, then by citations
2 of the 40 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Rammeh S, Ben Rejeb H, M'Farrej MK, et al. Cervical node fine needle aspi- ration: factors influencing the failure rate. Rev Stomatol Chir Maxillofac Chir Orale 2014;115:85-87.
- Velepic M, Vukelic J, Dvojkovic Z, Skrobonja I, Braut T. Middle ear tubercu- losis in an immunocompromised patient: case report and review of the lit- erature. J Infect Public Health 2020;14:139-142.
Cited by
Sorted by citations
Mogoantă, C. A., Osman, A., Georgescu, A.-M., Mitroi, A. M., Busuioc, C. I., Tănase, I., Cioboată, R., Liliac, I. M., Cimpeanu, O. L., & Ciolofan, M. S. (2025) · Pathogens · doi:10.3390/pathogens14050479 · Cited by 2 · see citing works
“…was found in patients with a history of migration to and from high TB burden areas or in those with immunosuppressive conditions [28], which is also seen in our Romanian cohort, as all our patients moved into dense urban areas from low-density rural areas 5 to 7 years previous to diagnosis [28].”
Gao, M., Cheng, L., Wang, Q., Yang, Q., Wang, X., Li, Y., Hu, R., & Xu, W. (2023) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2023.104115 · Cited by 2 · see citing works
Unusual Presentation of Extrapulmonary Tuberculosis as Laryngeal Mass in an Atypical Patient
Agarwal, R. D., Marino, M. D., Whalen, M. J., & Walker, R. J. (2024) · Case Reports in Medicine · doi:10.1155/carm/9912317 · Cited by 1 · see citing works
Faringitis y absceso periamigdalino
Dufour, X., & Carsuzaa, F. (2023) · EMC - Otorrinolaringología · doi:10.1016/s1632-3475(23)47634-5 · Cited by 1 · see citing works
Linfadenite granulomatosa necrotizante tuberculóide em paciente pediátrico: Relato de caso
Cunha, J. D. S., Sobral, A. P. V., Júnior, F. A. D. S., Barbosa, M. R., de Andrade, A. B. L., da Silva, M. B., Diniz, D. A., Maciel, F. A. C., & Neves, L. E. D. M. (2021) · Research Society and Development · doi:10.33448/rsd-v10i13.19213
Lower Cranial Nerve Palsy due to Prevertebral Tuberculosis Infection
Kim, N., Kim, H., Kang, I., & Kim, Y. S. (2021) · Journal of Neurosonology and Neuroimaging · doi:10.31728/jnn.2021.00104
A Giant Nodule of the Soft Palate Mimicking a Tumor: A Case of Oropharyngeal Tuberculosis
Mabrouki, A., Lachkar, A., Abdenbitsen, A., & Elayoubi, F. (2022) · Cureus · doi:10.7759/cureus.31891
Faringite e flemmone peritonsillare
Dufour, X., & Carsuzaa, F. (2023) · EMC - Otorinolaringoiatria · doi:10.1016/s1639-870x(23)47793-8
A Study on 18 Cases of Cervical Tuberculous Lymphadenitis
Nakagawa, H., Nishimura, B., & Harano, A. (2024) · Practica Oto-Rhino-Laryngologica · doi:10.5631/jibirin.117.767
Case of nasopharyngeal tuberculosis complicated with cervical lymph node and pulmonary tuberculosis
Cao, J., Gan, H., Wu, J.-H., Yuan, Y., & Ye, F. (2025) · Open Life Sciences · doi:10.1515/biol-2022-1041
Fan, Z., Dong, W., Wang, X., Han, L., Shi, S., Cao, Z., Qiao, Z., Zhang, X., & Liu, C. H. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13672-1
- Authors
- Gehrke, T., Hackenberg, S., Tecle, N., Hagen, R., & Scherzad, A.
- Affiliations
- Universitätsklinikum Würzburg (DE)
- Corresponding author
- Gehrke, Thomas
- Venue
- The Laryngoscope
- Publisher
- Wiley
- Published
- 2021-06-03
- Volume
- 131
- Issue
- 12
- Pages
- 2701-2705
- ISSN
- 0023-852X (ISSN-L)
- 1531-4995
- OpenAlex
- W3164705201
- Cited by
- 11
- References
- 40
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 2
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Laryngoscope (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion, cc-by-nc)
- Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by-nc)
- RWTH Publications (RWTH Aachen)
- Topics
- Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- extrapulmonary tuberculosis, head and neck tuberculosis, age-related patterns, differential diagnosis, tuberculous lymphadenitis, laryngeal tuberculosis, immunosuppression, migrant patients, misdiagnosis as malignancy, diagnostic pathway
- MeSH terms
- Adult, Age Factors, Biopsy, Female, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Oropharynx, Retrospective Studies, Risk Factors, Tuberculosis, Laryngeal, Tuberculosis, Lymph Node, Case-Control Studies, Emigrants and Immigrants
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