[Clinical Study of Skull Base Osteomyelitis]

Area of Science:

• Infectious Diseases
• Otolaryngology
• Neurosurgery

Background:

• Osteomyelitis of the skull base is a severe infection, frequently associated with Pseudomonas aeruginosa in elderly diabetic patients following malignant external otitis.
• The emergence of atypical forms of skull base osteomyelitis presents new diagnostic and therapeutic challenges.

Observation:

• A retrospective review of 5 male patients (mean age 75.2 years) with skull base osteomyelitis was conducted.
• Four patients had diabetes mellitus; 3 presented with typical osteomyelitis post-malignant external otitis, while 2 had atypical forms without temporal bone involvement.
• Cultures identified Pseudomonas aeruginosa in 4 cases and Aspergillus in one case.

Findings:

• Patients with typical osteomyelitis after malignant external otitis and those with atypical forms showed varied responses to intravenous antibiotics.
• Despite treatment, 3 out of 5 patients (60%) died, highlighting the poor prognosis.
• Pseudomonas aeruginosa was the predominant pathogen identified in culture samples.

Implications:

• The study underscores the need for heightened awareness of both typical and atypical skull base osteomyelitis, particularly in vulnerable populations.
• Prompt diagnosis and extended courses of targeted antibiotic therapy are essential for potentially improving patient survival rates.
• Further research into novel therapeutic strategies is warranted given the high mortality associated with skull base osteomyelitis.