Prevalence of Head and Neck Tuberculosis Presenting as Neck Masses in a Tertiary Care ENT Setting

Abstract

Background: Head and neck tuberculosis (HNTB), though less common than pulmonary TB, remains a significant health burden in Bangladesh. Cervical lymphadenitis is its most frequent manifestation, often mimicking malignancies or other infections, leading to diagnostic delays. This study evaluates HNTB prevalence, diagnostic challenges, and treatment outcomes at a tertiary hospital in Dhaka, emphasizing early detection and effective management in high-burden settings. Objectives: To assess HNTB prevalence, diagnostic approaches, and treatment outcomes among neck mass patients in a Bangladeshi tertiary hospital. Methods and Materials: A cross-sectional study was conducted on 112 neck mass patients from February 2018–January 2019. Diagnosis involved clinical evaluation, FNAC, histopathology, GeneXpert, and imaging. Confirmed HNTB cases received standard anti-tubercular therapy (ATT) and were monitored. Data were analyzed using SPSS v21. Ethical approval and informed consent were obtained. Result: The study of 112 patients revealed tubercular lymphadenitis as the most common diagnosis (41.1%), followed by reactive lymphadenitis (25.0%). Among 46 confirmed HNTB cases, Level II cervical nodes were most affected (47.8%). All patients presented painless neck swelling (100%), with 65.2% reporting low-grade fever. FNAC showed 84.8% sensitivity, while 60.9% had caseating granulomas on histopathology. Treatment success was 87.0%, with 6.5% experiencing mild hepatotoxicity. Most patients (39.1%) sought care after 4-8 weeks of symptoms. Conclusion: Head and neck tuberculosis is a common cause of neck masses, diagnosable by combined tests and effectively treated with standard anti-tubercular therapy.