Atypical Presentation of Skull Base Osteomyelitis Involving the Stylomastoid Foramen-A Case Report

Area of Science:

• Otolaryngology
• Neurosurgery
• Infectious Diseases

Background:

• Skull base osteomyelitis (SBO) typically presents with otalgia, otorrhea, and cranial nerve deficits.
• Malignant otitis externa is a common cause of SBO, often seen in diabetic patients.
• Atypical presentations of SBO can mimic other conditions, leading to diagnostic challenges.

Purpose of the Study:

• To report a rare case of SBO involving the stylomastoid foramen in a diabetic patient with an atypical presentation.
• To emphasize the diagnostic and therapeutic challenges posed by SBO without typical otoscopic findings or facial nerve palsy.
• To highlight the importance of considering SBO in diabetic patients with persistent ear pain, even without classic signs.

Main Methods:

• Case report of a 78-year-old male with poorly controlled diabetes mellitus.
• Patient presented with severe ear pain and headache, but no otoscopic findings or facial palsy.
• Initial treatment with intravenous antibiotics for two months was ineffective; surgical intervention was performed.

Main Results:

• High-resolution computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for diagnosing SBO.
• SBO unresponsive to prolonged intravenous antibiotics may necessitate surgical management, including debridement and abscess drainage.
• Surgical intervention in this case led to complete symptom relief.

Conclusions:

• Skull base osteomyelitis can present atypically, particularly in diabetic individuals, without the usual otoscopic findings or facial nerve involvement.
• Persistent temporal bone pain and headache in diabetic patients warrant thorough investigation for SBO.
• Surgical management should be considered for SBO cases refractory to conservative antibiotic treatment.