Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.

Although tuberculous infections of the ear are well reported in the scientific literature, infections with atypical mycobacteria are poorly represented. Nontuberculous mycobacterial isolates have become more common over the past few decades, and some reports have documented the emergence of these organisms at head and neck sites, t,2Mycobacterium fortuitum is a rapidly growing, Group IV organism that has been documented only twice in the otology literature of the United States. 3,4 We report a case of otomastoiditis caused by this organism and discuss the challenging treatment of this disorder in light of recent therapeutic developments. CASE REPORTA 14-year-old teenager came to the clinic complaining of otorrhea, which she had been experiencing for 5 days. She had had an episode of otorrhea the previous month. She had also received four sets of pressure equalizing tubes, the last at age 8 years, for recurrent otitis media. The patient was a competitive swimmer, swimming 3 miles a day, 6 days a week.An examination revealed otitis media and mild otitis externa with a pinpoint perforation in the anterior/superior quadrant that was only visible when a thick greenish-brown discharge was excreted with negative pressure. No tube was seen, and the left ear was normal. She was given amoxicillin and clavulanate orally and polymixin and neomycin drops topically. The patient did not experience any significant clinical improvement after l0 days, and her medication was changed to cefixime orally and a culture was obtained from her ear. No bacterial cultures grew, and her condition failed to improve. After 2 weeks of cefixime therapy, a pressure equalizing tube was placed in the right ear, and the oral antibiotics were changed to trimethoprim and sulfa. Her condition failed to improve after 14 days.Because of the failure of oral therapy, she was admitted to the hospital and was prescribed ampicillin and suIbactam. Her pressure equalizing tube, which had been placed 2 weeks previously, fell out around the time of admission and was From the Otolaryngology-Head and Neck Surgery Service (Dr.