title: Emergence of Refractory Otomastoiditis Due to Nontuberculous Mycobacteria: Institutional Experience and Review of the Literature.
abstract: BACKGROUND
  Nontuberculous mycobacteria (NTM) infection has attracted increasing attention in recent years; however, NTM otomastoiditis is extremely rare. Surgery combined with antibiotic therapy is the current mainstay of treatment; however, the reported duration of medication still varies. In this study, we aimed to analyze patients with NTM otomastoiditis and establish a more efficient treatment strategy.
  
  
  METHODS
  Medical records and temporal bone images of patients with NTM otomastoiditis were retrospectively analyzed. In addition, a comprehensive review of cases with NTM otomastoiditis in the literature was also performed.
  
  
  RESULTS
  Twenty-two patients were identified in our institution, and all patients had refractory otorrhea. The rates of granulation tissue, otalgia, and facial palsy were 90.9%, 31.8%, and 9.1%, respectively. Soft tissue attenuation via imaging studies was demonstrated in all of the middle ear cavities. All patients received medical treatment, 20 (90.9%) underwent surgery, and 4 (18.2%) underwent revision surgery. The median time to cure was similar between the "prolonged-course" and "standard-course" antibiotic groups (3.0 vs 3.3 months; P = .807). However, the former had a longer median duration of antibiotic therapy (6.0 vs 3.0 months; P = .01). In the literature review, 54 (96.4%) patients received medical treatment, 51 (91.1%) underwent surgery, and 27 (48.2%) underwent revision surgery.
  
  
  CONCLUSIONS
  NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery, which is the mainstay of treatment, should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after a dry ear is achieved.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.|Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center.
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Yeh
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.
authors.forename: Tzong-Yang
authors.initials: TY
authors.lastname: Tu
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.
authors.forename: Mao-Che
authors.initials: MC
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.
authors.forename: Chia-Huei
authors.initials: CH
authors.lastname: Chu
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.
authors.forename: Chii-Yuan
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital.|Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Wei-Juin
authors.initials: WJ
authors.lastname: Su
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.|Department of Otolaryngology, National Yang Ming University School of Medicine.|Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center.
authors.forename: An-Suey
authors.initials: AS
authors.lastname: Shiao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology*; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000187:drug effects / Q000382:microbiology*; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008417:Mastoiditis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D009170:Nontuberculous Mycobacteria / Q000187:drug effects; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology / Q000648:ultrastructure
chemical_list: D000900:Anti-Bacterial Agents
keywords: nontuberculous mycobacteria; otomastoiditis; revision; surgery