Bilateral Nontuberculous Mycobacterial Otitis Media: A Case Report

Area of Science:

• Infectious Diseases
• Otolaryngology
• Microbiology

Background:

• Nontuberculous mycobacterial (NTM) infections lack established treatment guidelines.
• The role of surgical intervention alongside antibiotic therapy for NTM otitis media is debated.
• Bilateral NTM otitis media presents unique challenges for hearing preservation.

Observation:

• A 27-year-old woman presented with chronic bilateral otorrhea.
• Cultures confirmed Mycobacterium abscessus in both ears, a highly antibiotic-resistant bacterium.
• The patient had impaired hearing in the right ear.

Findings:

• Combined antibiotic therapy (clarithromycin, amikacin, imipenem) and surgical debridement of the right middle ear were initiated.
• Otorrhea resolved, and hearing improved in both ears by day 38.
• Similar outcomes were observed in both surgically treated and non-surgically treated ears, indicating surgery may not be essential.

Implications:

• Surgical intervention may not be a mandatory component in treating bilateral Mycobacterium abscessus otitis media.
• These findings could inform future treatment guidelines for NTM infections.
• Further research is needed to solidify the role of conservative management in NTM otitis media.