This study aimed to assess the clinical presentation,
antibiotic therapy, surgery, and outcomes in patients with
otitis media caused by Mycobacterium abscessus subsp. abscessus and discuss the efficacy of surgery. This is a retrospective case review of three patients diagnosed with otomastoiditis caused by M. abscessus subsp. abscessus. All patients had refractory otorrhea. One patient had granulation tissue in the tympanic membrane. They received medical treatment and underwent surgery. Otorrhea was resolved several months after the initiation of long-term multiantibiotic
therapy in all cases. The timing of surgery varied among patients. Before initiating
antibiotic therapy,
mastoidectomy was performed to achieve definitive diagnosis in two patients, and
wound dehiscence developed in these patients. Two patients underwent
debridement after the initiation of multiantibiotic
therapy. After
antibiotic administration,
tympanoplasty was performed to improve hearing in one patient. All patients achieved culture negativity
after treatment, and no recurrences have been noted. From three cases, it is suggested that the mainstay of treatment for M. abscessus subsp. abscessus is long-term multiantibiotic
therapy, and surgery itself may have little effect on achieving ear dryness. Thus, in most patients,
drug therapy should be prioritized. Considering postoperative complications, surgery before achieving ear dryness should be avoided, except in emergency cases. In addition, if the diagnosis is not confirmed by repeated bacteriological tests,
mastoidectomy should be performed to collect specimens.
Tympanoplasty for
hearing loss or
eardrum perforation is recommended after discontinuation of medications.