CHRONIC OTITIS-MEDIA AFTER TYMPANOSTOMY TUBE PLACEMENT CAUSED BY MYCOBACTERIUM-ABSCESSUS - A NEW CLINICAL ENTITY

Infections with nontuberculous mycobacteria (NTM) are being identified with increasing frequency, but the otologic manifestations of NTM inf ection are not well defined. Mycobacterium abscessus is a ubiquitous r apidly growing mycobacterium (RGM) known to cause disease by inoculati on after trauma. Though reported following open heart and breast augme ntation surgery, it is not recognized as a cause of sporadic post-tymp anostomy tube otorrhea. This report presents detailed clinical informa tion on six sporadic cases and partial information on 15 additional ca ses of ear infection caused by RGM over the past 7 years. Of these, 20 of 21 cases (95%) were attributable to M. abscessus, 14 of 21 (67%) s ubjects lived in a southern coastal state and 16 of 16 with available histories had previously undergone placement of tympanostomy tubes. Ea ch isolate exhibited resistance to many antibiotics, with 50 percent e xhibiting high level mutational resistance to aminoglycosides related to prior topical aminoglycoside use. Therapy was difficult, requiring debridement and prolonged antibiotic therapy. M. abscessus is a proble matic infection requiring specific diagnosis and treatment and should be sought as a cause of refractory post-tympanostomy tube otorrhea.