Skull Base Osteomyelitis in Children: Clinical Characteristics and Potential Implications

Area of Science:

• Pediatric infectious diseases
• Skull base osteomyelitis
• Otolaryngology

Background:

• Skull base osteomyelitis (SBO) is a rare but serious infection in children.
• Otogenic SBO, originating from ear infections, is more common than nonotogenic SBO.
• Previously healthy children can be affected by SBO.

Purpose of the Study:

• To describe 10 new cases of pediatric SBO (8 otogenic, 2 nonotogenic).
• To review the existing literature on pediatric SBO.
• To highlight diagnostic and treatment challenges in pediatric SBO.

Main Methods:

• Retrospective analysis of 10 pediatric SBO cases (age 0.9-12.8 years) from 2015-2020.
• Inclusion of clinical evaluation, imaging (CT/MRI), and laboratory investigations.
• Review of literature on pediatric skull base osteomyelitis.

Main Results:

• Five patients presented with fever, and five with otological symptoms.
• Neurologic findings (nuchal rigidity, papilledema, apathy) were observed in 4 patients.
• Otogenic SBO required surgery (8/8), while nonotogenic SBO responded to antibiotics alone (2/2).

Conclusions:

• Early pediatric SBO diagnosis is difficult due to nonspecific symptoms.
• Magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosis.
• Surgical intervention is typically necessary for otogenic SBO; nonotogenic SBO may be managed non-surgically.