Skull Base Osteomyelitis: A Single-Center Experience

Abstract

BackgroundSkull base osteomyelitis (SBO) is an uncommon entity and carries a high mortality rate. It can be be odontogenic, sinogenic, or otogenic in origin, in addition to being a complication of skull surgery/trauma. Pseudomonas is one of the most commonly identified pathogen. The goal of the study is to describe the clinical spectrum, microbiologic characteristics, treatment, and its response among different patients with SBO. In addition, we compared the outcomes of bacterial and fungal osteomyelitis. MethodologyThis is a single-center retrospective analysis of patients with SBO who presented to Shaukat Khanum

Extensive Base of Skull Osteomyelitis: Why Does It Still Occur?

“…We reported a typical case of skull base osteomyelitis with otogenic origin. SBO is most commonly observed in male, diabetic, and immunocompromised patients [ 1 , 4 ]. SBO presents initially with non-specific symptoms, for example, headaches, fever, and elevated inflammatory markers, and as a sequel of malignant otitis externa [ 2 ].…”

“…SBO usually is an unfortunate complication of an improperly treated middle ear, nasal, or dental infection [ 2 , 4 ]. The diagnosis and treatment of SBO are particularly challenging for physicians.…”

“…The common presenting symptoms include a deep, throbbing, and persistent temporal headache accompanied by deep-seated otalgia with different presentations of otorrhea (mucopurulent, scanty, foul smelling, etc. ), facial palsy, fever, difficulty swallowing, and other neurological manifestations [ 4 ].…”

“…Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) are the most common causative agents. It is rarely caused by fungi such as Aspergillus or Mucor [ 1 , 4 ].…”

“…The treatment regimen is based on administering IV broad-spectrum antibiotics and surgical debridement in specific cases. Surgical debridement is necessary if there is abscess formation, extensive soft tissue infiltration, or in refractory cases [ 4 , 5 ]. New clinical guidelines stress the importance of combining hyperbaric oxygen therapy with the conventional treatment regimen [ 6 , 7 ].…”