Skull Base Osteomyelitis- Marauders of the Skull
Lakshmi Krishnakumar1, Vishnu Vinayakumar1, B R Suchit Roy1
1Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India.
Abstract:
Skull base osteomyelitis is a vicious infection of temporal bone associated with very high morbidity and mortality. But few studies have been undertaken recently for eliciting its increasing incidence. Hence this study aims to describe the clinical profile of skull base osteomyelitis and changes noted in the post-covid period, and encourage a uniform treatment policy globally. This descriptive study was conducted among 140 patients diagnosed with skull base osteomyelitis. Data was collected using semi-structured proforma, HRCT temporal bone findings, microbiological reports, histopathology of granulation tissue, ESR and House-Brackmann grading. Male patients in 61-70 age group were most commonly affected and all patients had uncontrolled diabetes mellitus, usually presenting with nocturnal otalgia, ear canal granulation and cranial nerve palsy. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. Among fungal pathogens, candida albicans were the most common. 29.3% patients had extensive disease according to Thakar et al. staging and on follow up, 43.75% patients showed a satisfactory response. Coronary artery disease and cerebrovascular accidents were the leading cause of death. More atypical organisms, extensive disease and changes in antibiotic sensitivity were noted in the post-covid period. Prolonged treatment with culture sensitive antibiotic is the main stay of treatment. A uniform treatment guideline is needed for proper management of such patients. Level of Evidence 4.
Insights
Skull base osteomyelitis, a severe temporal bone infection, is increasingly noted post-COVID. This study highlights clinical profiles and advocates for uniform global treatment guidelines for this dangerous condition.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Neurology
Background:
- Skull base osteomyelitis (SB0) is a severe temporal bone infection with high morbidity and mortality.
- Recent studies on its increasing incidence are limited.
- The post-COVID era may present unique challenges and changes in SB0.
Purpose of the Study:
- To describe the clinical profile of skull base osteomyelitis.
- To identify changes in SB0 during the post-COVID period.
- To encourage the development of a uniform global treatment policy.
Main Methods:
- A descriptive study of 140 patients diagnosed with SB0.
- Data collection included semi-structured proformas, HRCT temporal bone findings, microbiological and histopathological reports, ESR, and House-Brackmann grading.
- Analysis focused on clinical presentation, causative organisms, disease extent, and treatment response.
Main Results:
- The most affected demographic was males aged 61-70, all with uncontrolled diabetes mellitus.
- Common presentations included nocturnal otalgia, ear canal granulation, and cranial nerve palsy.
- Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacterial isolates; Candida albicans was the most common fungal pathogen. Post-COVID observations included atypical organisms, more extensive disease, and altered antibiotic sensitivity.
- 29.3% had extensive disease; 43.75% showed a satisfactory response to treatment. Coronary artery disease and cerebrovascular accidents were leading causes of death.
Conclusions:
- Prolonged, culture-sensitive antibiotic treatment is the mainstay for skull base osteomyelitis.
- The post-COVID period has seen shifts in SB0 characteristics, necessitating updated management strategies.
- A uniform global treatment guideline is crucial for effective patient management.
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