Related Experiment Videos
Osteomyelitis of the base of the skull
Abstract:
Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.
Insights
Skull base osteomyelitis, often caused by Pseudomonas aeruginosa, is an increasing concern. Early detection via imaging and prompt antibiotic treatment improves outcomes, making this once-fatal infection curable.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Neurosurgery
Background:
- Osteomyelitis of the skull base is an uncommon but growing infection.
- Typically arises from external auditory canal infections, predominantly by Pseudomonas aeruginosa.
Purpose of the Study:
- To report on the diagnosis and treatment of skull base osteomyelitis.
- To highlight the changing prognosis and treatment strategies for this condition.
Main Methods:
- Review of 17 diagnosed and treated cases of skull base osteomyelitis.
- Utilized technetium and gallium scintigraphy for early detection.
- Employed CT scans for assessing bone dissolution in advanced stages.
Main Results:
- Headache is the primary symptom.
- Cranial nerve involvement (dysphagia, hoarseness, aspiration) indicates disease progression.
- Overall mortality is 53%, but recent outcomes show improvement with 6 of the last 8 patients surviving.
Conclusions:
- Skull base osteomyelitis is now a curable disease with appropriate medical management.
- Long-term intravenous administration of an aminoglycoside and a broad-spectrum semisynthetic penicillin is the recommended treatment.
- Early diagnosis and intervention are crucial for improving patient survival rates.