Osteomyelitis of the Skull Base with Atypical Onset and Evolution

Magliulo, Giuseppe; Varacalli, S; Ciofalo, Andrea

doi:10.1177/000348940010900316

Cited by 25 publications

(13 citation statements)

References 14 publications

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“…First described in 1959 by Meltzer and Kelemen [1], skull‐base osteomyelitis (SBO) is an uncommon condition associated with significant morbidity and mortality [2–4]. Subsequently, our understanding of SBO is derived from case reports or small series in the surgical literature [1–15]. The entity has been described most often as a complication of malignant otitis externa secondary to Pseudomonas aeruginosa infection [5,16].…”

Section: Introductionmentioning

confidence: 99%

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Skull-base osteomyelitis: fungal vs. bacterial infection

Blyth

Gomes

Sorrell

et al. 2011

Clinical Microbiology and Infection

104

102

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Skull-base osteomyelitis (SBO) occurs secondary to invasive bacterial and fungal infection. Distinguishing between fungal and bacterial aetiologies of SBO has significant therapeutic implications. An 18-year (1990-2007) retrospective review of patients with SBO presenting to Westmead Hospital was performed. Epidemiological, clinical, laboratory and radiology data were collated. Twenty-one patients (median age 58 years) with SBO were identified: ten (48%) had bacterial and 11 (52%) had fungal SBO. Diabetes mellitus (57%) and chronic otitis externa (33%) were the most frequent co-morbidities; immunosuppression was present in five cases (24%). Cranial nerve deficits occurred in ten (48%) patients. The commonest pathogens were Pseudomonas aeruginosa (50% bacterial SBO) and a zygomycete (55% fungal SBO). Compared to bacterial SBO, fungal SBO was more frequently associated with underlying chronic sinusitis, sinonasal pain, facial/periorbital swelling and nasal stuffiness or discharge and the absence of purulent ear discharge (all p <0.05). Bacterial SBO was more frequently associated with deafness, ear pain or ear discharge (all p <0.05). Median time to presentation was longer in patients with bacterial SBO (26.3 weeks vs. 8.1 weeks, p 0.08). Overall 6-month survival was 88% (14/18 patients). All four deaths occurred in patients with fungal SBO. Immunosuppression was a risk factor for death (p <0.05). Early diagnostic sampling is recommended in patients at increased risk of fungal SBO to enable optimal antimicrobial and surgical management.

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Section: Introductionmentioning

confidence: 99%

“…SBO, however, may also occur in the absence of malignant otitis externa and with pathogens other than P. aeruginosa , including fungi [3,7,8,12–14,17]. Fungal SBO has been reported to be mostly caused by Aspergillus, and less commonly, Scedosporium spp.…”

Section: Introductionmentioning

confidence: 99%

Skull-base osteomyelitis: fungal vs. bacterial infection

Blyth

Gomes

Sorrell

et al. 2011

Clinical Microbiology and Infection

104

102

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“…Patients with skull base osteomyelitis face a challenge in diagnosis and treatment [13,14] . When nasopharyngeal carcinoma was not an uncommon disease in Taiwan, these patients were initially suspected to have nasopharyngeal carcinoma and received repeated nasopharyngeal biopsies [15] .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Sinus Surgery for the Management of Orbital Diseases

Liang

Su²,

Shiao

et al. 2008

ORL

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The indications for endoscopic sinus surgery (ESS) have been widely expanding since its introduction into sinus surgery. ESS has become an ideal method to manage certain orbital diseases and has the advantages of excellent visualization with minimal cosmetic and functional morbidity. In the Department of Otolaryngology of Taichung Veterans General Hospital from 1988 to 2005, 3,136 patients received ESS. Among them, a total of 108 patients received ESS for orbital diseases. These orbital diseases included orbital complications secondary to bacterial rhinosinusitis, fungal rhinosinusitis, skull base osteomyelitis and mucoceles, subperiosteal hematoma, Graves’ disease, traumatic optic neuropathy and orbital blowout fracture. Our results showed that ESS is effective in the management of some of these orbital diseases.

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“…While it is open, the membranous labyrinth is kept wet with Ringer’s solution and no suction is applied close to the openings of the semicircular canals in order to protect the anatomy and function of the membranous labyrinth of the vestibule. Using a cottonoid, the closure of the fistula is then reinforced with bone paste and temporalis fascia 3–5 . This allowed us to preserve the vestibule with the openings of the semicircular canals sealed (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…A further treatment possibility that was proposed recently is the immediate removal of the matrix combined with removal of the affected semicircular canal, or ‘partial labyrinthectomy’. While this may seem radical, rationale exists in the principle of eliminating all of the infective and inflammatory processes that could in the future compromise hearing function 3–5 . Van den Abeele and Offeciers 3 and Kobayashi et al 4 proposed this alternative strategy that draws from the experiences of Parnes and McClure 6 for the treatment of benign paroxysmal vertigo (occlusion of the posterior semicircular canal) and from those of numerous other authors for the treatment of skull‐base lesions while preserving hearing function 7–9 .…”

mentioning

confidence: 99%