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Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation

Amar Singh1, Mazin Al Khabori, M Jamil Hyder

  • 1Department of Otorhinolaryngology-Head and Neck Surgery and Communication Disorder, Al Nahdha Hospital, Muscat, Sultanate of Oman. ankit@omantel.net.om

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|July 19, 2005
PubMed
Abstract

Insights

Masked skull base osteomyelitis from malignant otitis externa presents diagnostic challenges. Early recognition of atypical symptoms and advanced imaging are crucial for managing this severe condition.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Radiology

Background:

  • Malignant otitis externa (MOE) can lead to skull base osteomyelitis (SBOM).
  • SBOM secondary to MOE presents diagnostic and management difficulties, especially in recurrent or atypical cases.

Observation:

  • This study analyzed 3 elderly diabetic patients with inadequately treated MOE who developed recurrent SBOM.
  • Atypical manifestations included contralateral SBOM and cranial nerve involvement.
  • High morbidity and mortality were observed, with 2 of 3 patients succumbing to the disease despite aggressive treatment.

Findings:

  • Recurrent SBOM in MOE cases exhibits atypical symptoms: severe otalgia, unremitting headache, elevated ESR, and unilateral otitis media with effusion.
  • Diagnostic clues necessitate further investigation with CT, MRI, and nuclear scintigraphy (Technetium 99, Gallium 67).

Implications:

  • Prompt diagnosis and aggressive management, including antibiotics and hyperbaric oxygen therapy, are vital for improving outcomes.
  • Establishing clear diagnostic criteria for recurrent SBOM secondary to MOE is essential for timely intervention.

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