Author(s)
Eve Sedillot, MD1
Beatrice Voizard, MD1
Marie-Claude Quintal, MD, FRCSC2
Affiliation(s)
1Medicine, Univ. of Montreal, Montreal, Canada, 2CHU Sainte-Justine, Montreal, Canada
Abstract:
Introduction: 8 new cases of chronic otitis media with atypical mycobacteria were reported at CHU Sainte-Justine between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This series of cases aims to define the clinical presentation, infectious strains, as well as diagnosis and therapeutic means employed in cases of nontuberculous mycobacteria encountered in our reference center.
Methods: All cases of atypical mycobacteria diagnosed at CHU Ste-Justine between 2008 and 2018 were reviewed. Strains' identification was extracted from the data of the Public Health Laboratory of Quebec.
Results: Over 8 cases, all were immunocompetent. Typical presentation was chronic otorrhea on transtympanic tubes with abundant granulation tissue for 7/8 cases. CT scan demonstrated coalescent mastoiditis in 3/8 cases. Average time between initial presentation and identification of atypical mycobacterium was 119 days. The majority (7/8) of patients had Mycobacterium abcessus infection. Treatment consisted of a weekly cleaning of the middle ear, a systemic antibiotic triple therapy of an average duration of 21 weeks, as well as instillation of boric acid in the middle ear. While 3/8 cases required at least one mastoidectomy, 2/8 cases were treated only medically.
Conclusion: Atypical mycobacterium otitis is a rare clinical entity, for which high clinical suspicion minimizes diagnostic delay. The use of boric acid as a desiccant may minimize surgical procedures.