Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria-Still a Clinical Challenge

Area of Science:

• Otolaryngology
• Pediatric Infectious Diseases
• Microbiology

Background:

• Subacute mastoiditis (SAM) is an indolent infection posing diagnostic and therapeutic challenges.
• A potential link exists between SAM and nontuberculous mycobacteria (NTM) infections.
• Aggressive temporal bone destruction and complications necessitate further investigation into SAM.

Purpose of the Study:

• To investigate the clinical features of pediatric subacute mastoiditis (SAM).
• To identify optimal treatment strategies for SAM.
• To analyze outcomes and complications in pediatric SAM cases.

Main Methods:

• Retrospective survey of pediatric patients (0-17 years) hospitalized with SAM from 2003-2023.
• Data collection included demographics, diagnostics (radiology, microbiology, histopathology), treatment, and clinical outcome.
• Analysis of 16 pediatric cases at Karolinska University Hospital, Sweden.

Main Results:

• Sixteen pediatric cases of SAM were identified, with a median age of 7.5 years.
• Nontuberculous mycobacteria (NTM) infection was detected in six cases.
• Most cases involved longstanding otorrhea, temporal bone destruction on CT, and granulomatous inflammation on histopathology; seven cases had delayed recovery or relapse.

Conclusions:

• Histopathological and microbiological sampling, alongside CT scans, are crucial for diagnosing SAM.
• Surgical intervention combined with empirical long-term antimycobacterial treatment is suggested for optimal recovery.
• Early diagnosis and targeted treatment are essential for managing pediatric SAM and preventing complications.