Management of non-tuberculous mycobacterial peri-sialadenitis in children: the Sheffield otolaryngology experience.

Non-tuberculous mycobacterial infection (NTM) has been recognized as an important cause of infection in the head and neck in children since 1956. It is important to differentiate NTM from the more serious Mycobacterium tuberculosis (TB) since the management differs significantly. The causative organisms of NTM infection are resistant to the most commonly used anti-tuberculous preparations, though they do show sensitivity to the newer antibiotics such as clarithromycin, ciprofloxacin and azithromycin. Between 1986 and 1997, 15 patients with NTM infection involving the major salivary glands were treated at the Sheffield Children's Hospital Department of Otolaryngology. There were 11 girls and four boys. In all patients the onset of symptoms was between September and April. Resolution occurred in two patients without surgery. The remaining 13 underwent formal surgical exploration with excision of the mass, associated nodes and of the overlying skin if necessary. There were nine parotid explorations. There were no long-term facial nerve deficits as a result of surgery and no recurrence of the disease. Co-operation between the Paediatrician and the Otolaryngologist is important for effective management since NTM may also affect the lungs, soft tissues, bones and joints. Diagnosis relies upon culture, histology, chest radiography, purified protein derivative (PPD) testing, clinical features and skin testing. The use of antibiotics such as azithromycin with ciprofloxacin may be justified while waiting for the results of investigations, especially with small, early lesions, as resolution is possible. In patients who have no history of exposure to TB, are not immunocompromised, have a normal chest radiograph and have a Mantoux test with < 15 mm diameter induration, the treatment should be surgical excision rather than prolonged antibiotic therapy.