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[Clinical Study of Skull Base Osteomyelitis]
Abstract:
Typical osteomyelitis is reportedly caused by Pseudomonous aeruginosa in elderly diabetic patients after malignant external otitis. Recently, complications have arisen due to the emergence of atypical osteomyelitis. We have experiensed 5 cases of skull base osteomyelitis at our hospital. All patients were male with a mean age of 75.2 years. Four patients had diabetes. Regarding the clinical and radiographic findings, patients 1, 2, and 3 had typical osteomyelitis after malignant external otitis, whereas patients 4 and 5 had atypical osteomyelitis without temporal bone findings. Sample culturing revealed Pseudomonas aeruginosa in 4 cases and Aspergillus in one. Intravenous antibiotics were administered to all patients. Two patients responded positively and survived, while 3 died. Typical osteomyelitis is reportedly caused by P. aeruginosa in elderly diabetic patients after malignant external otitis. Recently, complications have arisen due to the emergence of atypical osteomyelitis. The prognosis of skull base osteomyelitis is still poor in Japan. Early diagnosis and long-term antibiotic administration is required to improve outcome.
Insights
Skull base osteomyelitis, often caused by Pseudomonas aeruginosa in elderly diabetics, presents challenges with atypical forms emerging. Early diagnosis and prolonged antibiotic treatment are crucial for improving outcomes in this severe condition.
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.
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