Actinomyces infection of the middle ear - a case report

Actinomyces is a class of bacteria that are normally reckoned to the skin flora. Still, in rare cases the can also lead to an infection. A rarity the actinomyces induced middle ear infection. All over the world only about 50 cases have been reported.

A 50-year-old woman presents with more than 5 years of right-sided otalgia, recurrent otitides and hearing loss. The clinical aspect lead to the suspicion of chronic otitis media and a cMRI to the suspicion of a cholesteatoma. The indication for a tympanoplasty was given. Intraoperatively, the timpani mucosa was hyperplastic polyposically. In the attic area there was a whitish-yellowish smooth structure, not cholesteatoma-like. Histology suggested non-invasive actinomycetes. Since the pathology was completely removed, a long-term antibiotic was dispensed with. After the initial improvement after a couple of month, there was a new conductive hearing loss and oppressive pain. With intact, thickened but irritable eardrum, a second-look operation was planned, in which the timpani mucosa was massively inflamed with purulent to brittle secretion. The histolopathological findings revealed actinomyces, microbiologically only one staphylococcus auricularis was shown. After consultation with microbiology, amoxicillin/clavulanic acid was given for one month. In the follow-up checks (4 months) an irritable middle ear was shown.

Since actinomyces belong to the physiological skin flora, they are frequently not counted as pathological. Still, they remain an important differential diagnosis if the findings are unclear and can also be proven histologically. Actinomyces infection in the ear should be surgically rehabilitated and extendedly treated with antibiotics.

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Publication History

Article published online:
10 June 2020