Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge
ABSTRACT Objective An indolent form of mastoiditis has gained increased attention lately, challenging clinicians both regarding diagnosis as well as treatment. The etiology behind this assumed infection herein named subacute mastoiditis (SAM) is unknown; however, a link to nontuberculous mycobacteri...
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| Format: | Article |
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Wiley
2025-06-01
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| Series: | Laryngoscope Investigative Otolaryngology |
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| Online Access: | https://doi.org/10.1002/lio2.70183 |
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| author | Lara Kakabas Anna Granath Kaijsa Edholm Julia Arebro |
| author_facet | Lara Kakabas Anna Granath Kaijsa Edholm Julia Arebro |
| author_sort | Lara Kakabas |
| collection | DOAJ |
| description | ABSTRACT Objective An indolent form of mastoiditis has gained increased attention lately, challenging clinicians both regarding diagnosis as well as treatment. The etiology behind this assumed infection herein named subacute mastoiditis (SAM) is unknown; however, a link to nontuberculous mycobacteria (NTM) infections has been seen. A survey on pediatric cases with SAM over 20 years was performed to investigate the typical clinical features and to identify optimal treatment strategies for this condition, causing aggressive temporal bone destructions along with intratemporal and intracranial complications. Methods A retrospective survey of pediatric patients (0–17 years) hospitalized with SAM during 2003–2023 at Karolinska University Hospital, Sweden, was conducted. Data collection included demographics, diagnostics (radiology, microbiology, histopathology), treatment, and clinical outcome. Results Sixteen cases (median age 7.5 years) with SAM were included. Longstanding otorrhea from ventilation tubes preceded clinical signs of mastoiditis in most cases. CT scan generally revealed cortical temporal bone destructions close to the ear canal and sigmoid sinus. Histopathological examination displayed a high incidence of granulomatous inflammation. Upon microbiological testing, six cases revealed NTM infection. All cases underwent mastoidectomy, and 11 cases received long‐term mycobacteria‐targeted antibiotics. No deaths occurred, but seven cases had a delayed recovery or relapsing disease, and several cases experienced complications. The long‐term outcomes were good. Two cases with Mycobacterium tuberculosis mastoiditis were identified, entailing diagnostic challenges. Conclusion Histopathological and microbiological sampling along with CT scan is crucial in diagnosing SAM. We suggest surgical intervention combined with empirical long‐term antimycobacterial treatment for optimal recovery and outcome in SAM. Level of Evidence 4 |
| format | Article |
| id | doaj-art-d9189653c45545d8bea4e59e1f78e9ff |
| institution | Kabale University |
| issn | 2378-8038 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Laryngoscope Investigative Otolaryngology |
| spelling | doaj-art-d9189653c45545d8bea4e59e1f78e9ff2025-08-20T03:30:04ZengWileyLaryngoscope Investigative Otolaryngology2378-80382025-06-01103n/an/a10.1002/lio2.70183Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical ChallengeLara Kakabas0Anna Granath1Kaijsa Edholm2Julia Arebro3Division of Otorhinolaryngology, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm SwedenDivision of Otorhinolaryngology, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm SwedenDepartment of Neuroradiology Karolinska University Hospital Stockholm SwedenDivision of Otorhinolaryngology, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm SwedenABSTRACT Objective An indolent form of mastoiditis has gained increased attention lately, challenging clinicians both regarding diagnosis as well as treatment. The etiology behind this assumed infection herein named subacute mastoiditis (SAM) is unknown; however, a link to nontuberculous mycobacteria (NTM) infections has been seen. A survey on pediatric cases with SAM over 20 years was performed to investigate the typical clinical features and to identify optimal treatment strategies for this condition, causing aggressive temporal bone destructions along with intratemporal and intracranial complications. Methods A retrospective survey of pediatric patients (0–17 years) hospitalized with SAM during 2003–2023 at Karolinska University Hospital, Sweden, was conducted. Data collection included demographics, diagnostics (radiology, microbiology, histopathology), treatment, and clinical outcome. Results Sixteen cases (median age 7.5 years) with SAM were included. Longstanding otorrhea from ventilation tubes preceded clinical signs of mastoiditis in most cases. CT scan generally revealed cortical temporal bone destructions close to the ear canal and sigmoid sinus. Histopathological examination displayed a high incidence of granulomatous inflammation. Upon microbiological testing, six cases revealed NTM infection. All cases underwent mastoidectomy, and 11 cases received long‐term mycobacteria‐targeted antibiotics. No deaths occurred, but seven cases had a delayed recovery or relapsing disease, and several cases experienced complications. The long‐term outcomes were good. Two cases with Mycobacterium tuberculosis mastoiditis were identified, entailing diagnostic challenges. Conclusion Histopathological and microbiological sampling along with CT scan is crucial in diagnosing SAM. We suggest surgical intervention combined with empirical long‐term antimycobacterial treatment for optimal recovery and outcome in SAM. Level of Evidence 4https://doi.org/10.1002/lio2.70183Mycobacterium tuberculosisnontuberculous mycobacteriapediatricsubacute mastoiditisventilation tube |
| spellingShingle | Lara Kakabas Anna Granath Kaijsa Edholm Julia Arebro Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge Laryngoscope Investigative Otolaryngology Mycobacterium tuberculosis nontuberculous mycobacteria pediatric subacute mastoiditis ventilation tube |
| title | Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge |
| title_full | Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge |
| title_fullStr | Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge |
| title_full_unstemmed | Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge |
| title_short | Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge |
| title_sort | subacute mastoiditis without verified nontuberculous mycobacteria still a clinical challenge |
| topic | Mycobacterium tuberculosis nontuberculous mycobacteria pediatric subacute mastoiditis ventilation tube |
| url | https://doi.org/10.1002/lio2.70183 |
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