Paediatric <i>Mycobacterium Avium</i> Complex Otomastoiditis: Case Series and Literature Review

This case series details two paediatric cases of <i>Mycobacterium avium</i> complex (MAC) mastoiditis that presented to the same hospital within three years of each other and were successfully managed. One female and one male patient, both pre-school aged, presented with otorrhoea and postauricular oedema unresponsive to intravenous antibiotics. Imaging demonstrated opacification of the mastoid air cells and middle ear with cortical breaks, and surgical exploration revealed granulation tissue in the mastoid cavity and antrum on gross and histopathological examination, as well as bony dehiscence. Mycobacterial culture revealed acid fast bacilli and polymerase chain reaction confirmed MAC infection. Both children received antimycobacterial agents and mastoidectomies. This series highlights the importance of considering atypical organisms when managing resistant mastoiditis, especially given the outcomes of sub-optimal management (such as conductive hearing loss, facial nerve palsy and meningitis). We suggest effective management based on our cases and the literature.