未证实非结核分枝杆菌的亚急性乳突炎-仍是一个临床挑战

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-06-22 DOI:10.1002/lio2.70183

Lara Kakabas, Anna Granath, Kaijsa Edholm, Julia Arebro

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引用次数: 0

摘要

目的一种惰性形式的乳突炎最近引起了越来越多的关注，对临床医生的诊断和治疗都提出了挑战。这种假定感染的病因在本文中称为亚急性乳突炎（SAM），目前尚不清楚；然而，已发现与非结核分枝杆菌（NTM）感染有关。我们对20多年来的儿童SAM病例进行了调查，以探讨典型的临床特征，并确定最佳的治疗策略，这种疾病导致侵袭性颞骨破坏以及颞内和颅内并发症。方法回顾性调查2003-2023年在瑞典卡罗林斯卡大学医院住院的0-17岁的小儿急性口腔炎患者。数据收集包括人口统计学、诊断（放射学、微生物学、组织病理学）、治疗和临床结果。结果本组共16例SAM患者，中位年龄7.5岁。在大多数病例中，通气管引起的长期耳漏先于乳突炎的临床症状。CT扫描一般显示靠近耳道和乙状窦的颞骨皮质破坏。组织病理学检查显示肉芽肿性炎症高发。经微生物检测，6例显示NTM感染。所有病例均行乳突切除术，其中11例长期接受分枝杆菌靶向抗生素治疗。无死亡病例发生，但有7例恢复迟缓或病情复发，数例出现并发症。长期效果很好。两例结核分枝杆菌乳突炎确诊，涉及诊断挑战。结论组织病理学、微生物学及CT扫描对SAM的诊断至关重要。我们建议手术干预结合经验性长期抗细菌治疗，以获得最佳的SAM恢复和预后。证据级别4

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Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge

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Subacute Mastoiditis Without Verified Nontuberculous Mycobacteria—Still a Clinical Challenge

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.