ATYPICAL MYCOBACTERIAL OTOMASTOIDITIS

Atypical mycobacterial infections of the middle ear and mastoid are ra re; only 4 isolated cases and an outbreak of 17 cases have been report ed. Herein are presented three additional cases with chronic otorrhea unresponsive to routine medical therapy. Two were due to Mycobacterium avium-intracellulare and the third to Mycobacterium chelonei. All thr ee patients had negative tuberculin test results and normal chest radi ographs. Pathologic study reveals granulomatous inflammation, usually with negative acid-fast stains. Tissue culture should be incubated for a minimum of 4 weeks, These patients often undergo multiple otologic procedures and have abundant granulation tissue with normal ossicles. The antibiotic therapy is prolonged, and the organisms may be resistan t to the usual antituberculous drugs. Unlike many atypical mycobacteri al infections today, those involving the middle ear can occur in immun ologically normal individuals.