Pediatric middle ear actinomycosis: report of two cases.

BACKGROUND: Middle ear actinomycosis is a rare condition, with approximately 50 reported cases in the literature. It typically occurs due to dissemination through the Eustachian tube from the nasopharynx to the middle ear and mastoid cavity and presents as chronic suppurative otitis media (CSOM), requiring long-term antibiotics and surgical debridement. CASE DESCRIPTION: We present two pediatric patients with middle ear actinomycosis. The first is a 7-year-old boy with Joubert syndrome who presented with right-sided persistent otorrhea 6 months after ventilation tube (VT) insertion. Histopathological analysis after surgical exploration showed actinomycosis. The patient underwent another debridement for persistent infection, followed by 3 months course of antibiotics to resolve the infection. The second case was that of a 10-year-old girl with no significant medical history who presented with 4 months history of left-sided otorrhea resistant to multiple courses of oral and topical antibiotics. Histopathological examination of the surgically debrided tissue revealed actinomycosis. The infection resolved after surgical debridement and 3 months course of oral antibiotics. CONCLUSIONS: Middle ear actinomycosis is a rare cause of persistent otorrhea in the pediatric population and should be suspected in resistant infections to conventional treatment.