Skull Base Osteomyelitis- Microbiological Profile and Management Implications

Skull base osteomyelitis (SBO) is a potent life-threatening infection that can be either otogenic, rhinogenic or odontogenic in origin. The characteristic features of this disease include severe nocturnal pain and cranial nerve palsies, thus causing severe morbidity and even mortality. Clinical data of 134 patients diagnosed with Skull base Osteomyelitis were retrospectively reviewed, and their demographic details, clinical features, surgical procedure, microbiolgical profile were analysed. In this cohort, 123 patients underwent targeted biopsy and debridement, which showed a male preponderance with a mean age of 60 and uncontrolled diabetes with a mean HbA1C of 8.4. The most common symptom was severe otalgia followed by facial nerve palsy. 85.4% of the patients were culture-positive and 14.6% were culture-negative. Pseudomonas spp was isolated in 32.6%, followed by Aspergillus spp (26%), Staphylococcus spp (25%) and atypical organisms (37%). The patients who underwent targeted biopsy and debridement followed by culture-specific antibiotics for appropriate duration showed 85% improvement in clinical symptoms with a significant improvement in culture positive group (p<0.05). SBO, a potent fatal infection, can be secondary to bacterial or fungal infection. Early diagnosis and targeted biopsy may yield a culture-positive rate of 84.6%. Treatment with long-term culture-specific antibiotics/antifungals has improved clinical outcomes.