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Pediatric Otolaryngology

(1009) Clinical Presentation, Diagnostic Work-Up, and Management of Pediatric Otologic Atypical Mycobacterial Infections: A Systematic Review

Saturday, October 17, 2026

Presenting Author(s)

Robin J. Reinke Cullinane, MS

Medical Student
Medical College of Wisconsin
Hampton, New Hampshire, United States

Co-Author(s)

GM

Geethanjeli Mahendran, MD

Clinical Resident in Otolaryngology Head and Neck Surgery
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts, United States
EW

Emily Wright, MD

Clinical Resident in Otolaryngology Head and Neck Surgery
Emory University, United States
HA

Hasan Abdulbaki, MD

Clinical Resident in Otolaryngology Head and Neck Surgery
Massachusetts Eye and Ear Infirmary, United States
DG

Deborah Goss, MLS

Medical Librarian
Massachusetts Eye and Ear Infirmary, United States

Senior Author(s)

NG

Nandini Govil, MD

Associate Professor, Otolaryngology-Head and Neck Surgery, Emory University School of Medicine
Emory University School of Medicine, Children's Healthcare of Atlanta, Georgia, United States

Introduction: With increasing recognition of atypical mycobacterium as a cause of pediatric otologic disease, clinicians face challenges in diagnosis and management due to variable presentation and limited standardized guidelines, indicating the need for a comprehensive review. Through this systematic review we summarize the clinical presentation, diagnostic evaluation, and treatment strategies for pediatric patients presenting with otologic manifestations of atypical mycobacterium.

Methods: Databases included PubMed, Embase, Web of Science, and the Cochrane Library. Eligible studies reported otologic manifestations of atypical mycobacterium in pediatric patients, including presentation, work-up, and management. Two reviewers independently screened studies and extracted data; low-quality studies were excluded. Outcomes included presenting symptoms, examination findings, diagnostic work-up, and medical and surgical management.

Results: Thirty-one studies (predominantly case reports/series) were included. Recurrent ear infections were reported in 28/31 (90.3%) studies and prior tympanostomy tubes in 26/31 (83.9%). Presentation most often included otorrhea (30/31, 96.8%) and external auditory canal granulation tissue/polyp (25/31, 80.6%); postauricular swelling occurred in 14/31 (45.2%) and hearing loss in 10/31 (32.3%). AFB stain was reported in 27/31 (87.1%) and mycobacterial culture in 30/31 (96.8%); temporal bone CT was obtained in 24/31 (77.4%). All patients underwent surgical and medical management. Surgical intervention including mastoidectomy (n=27, 87.1%) and tympanostomy (n=22,71%). Prolonged often multi-agent macrolide-based regimens were used in (n=24, 77.4%) of cases with mean treatment duration of 6 months (IQR 1.96-8.29).

Conclusions: Pediatric otologic atypical mycobacterial infections present diagnostic and therapeutic challenges due to nonspecific symptoms and lack of standardized guidelines. This review identifies consistent clinical patterns and management strategies that may support earlier recognition and more standardized care.