Skull base osteomyelitis: current microbiology and management

Spielmann, Patrick; Yu, Runze; Neeff, Michel

doi:10.1017/s0022215112002356

Cited by 37 publications

(30 citation statements)

References 25 publications

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“…Ciprofloxacin has since been widely used in the treatment of osteomyelitis of the temporal bone. 25,26 Antibiotic therapy can last several months. However, there have been recent reports of resistance of Pseudomonas to ciprofloxacin therapy in temporal bone osteomyelitis.…”

Section: Treatmentmentioning

confidence: 99%

Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

Prasad

Kumar

et al. 2014

J Neurol Surg B Skull Base

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Objectives?To review the terminology, clinical features, and management of temporal bone osteomyelitis. Design and Setting?Prospective study in a tertiary care center from 2001 to 2008. Participants?Twenty patients visiting the outpatient department diagnosed with osteomyelitis of the temporal bone. Main Outcome Measures?The age, sex, clinical features, cultured organisms, surgical interventions, and classification were analyzed. Results?Of the 20 cases, 2 (10%) were diagnosed as acute otitis media. Eighteen (90%) had chronic otitis media. Nineteen (95%) were classified as medial temporal bone osteomyelitis and one (5%) as lateral temporal osteomyelitis. The most common clinical features were ear discharge (100%), pain (83%), and granulations (100%). Facial nerve palsy was seen in seven cases (35%) and parotid involvement in one case. Ten patients (56%) had diabetes mellitus. The organisms isolated were Pseudomonas aeruginosa (80%) and Staphylococcus aureus (13.33%). Histopathology revealed chronic inflammation in 20 patients (100%) and osteomyelitic bony changes in 14 (70%). Surgical debridement was the most preferred modality of treatment (87%). Conclusion?A new classification of temporal bone osteomyelitis has been proposed. Bacterial cultures must be performed in all patients. Antibiotic therapy is the treatment of choice. Surgical intervention is necessary in the presence of severe pain, complications, refractory cases, or the presence of bony sequestra on radiology.

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Section: Treatmentmentioning

confidence: 99%

Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

Prasad

Kumar

et al. 2014

J Neurol Surg B Skull Base

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“…Pseudomonas aeruginosa is the commonly isolated organism, representing more than 50% in most of the series, followed by methicillin-resistant Staphylococcus aureus and Klebsiella pneumonia ( Chen et al., 2010 ; Ali et al., 2010 ; Loh and Loh, 2013 ; Stern Shavit et al., 2016 ; Lee et al, 2008, 2017; Hobson et al., 2014 ; Le Clerc et al., 2014 ). Though the causative organism was identified to be Pseudomonas in our case, the culture reports may not always yield positive results ( Ali et al., 2010 ; Loh and Loh, 2013 ; Lee et al, 2008, 2017; Spielmann et al., 2013 ; Le Clerc et al., 2014 ; Sokołowski et al., 2019 ). Irrespective of the culture reports, the empirical treatment with ceftazidime and fluoroquinolone combination has been shown to be equally efficacious as culture-directed antibiotic therapy in MOE ( Loh and Loh, 2013 ; Sokołowski et al., 2019 ).…”

Section: Discussionmentioning

confidence: 56%

“…Malignant otitis externa (MOE) also known as otogenic skull base osteomyelitis (SBO) is an inflammatory condition of the external ear and adjacent temporal bone that is commonly seen in diabetic patients, and is attributed to Pseudomonas infection ( Karaman et al., 2012 ; Blyth et al., 2011 ; Chen et al., 2010 ; Carfrae and Kesser, 2008 ; Ali et al., 2010 ; Das et al., 2019 ; Loh and Loh, 2013 ; Stern Shavit et al., 2016 ; Lee et al., 2008 ; Spielmann et al., 2013 ). Despite aggressive antibiotic therapy, many of the affected patients have an extension of the disease to surrounding soft tissue and bones of the skull base ( Chen et al., 2010 ; Carfrae and Kesser, 2008 ).…”

Section: Introductionmentioning

confidence: 99%

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

Devaraja

Nayak

2020

Journal of Otology

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Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa, which typically spreads to skull base to involve cranial nerves VII. Rarely can it also effect one or more of cranial nerves IX, X, XI, and XII. We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve. The patient though later on had internal jugular vein thrombosis, which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis, and later on, to aggravate the therapy. With proper blood sugar control and appropriate long term antibiotics, not only that the patient is disease free at one year follow up, but the cranial nerve deficits also recovered. Apart from sharing the clinical and management details of this patient, we have reviewed the relevant literature in the discussion, which has shed some light onto some of the interesting facts about this condition and its prognosis.

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“…In the differential diagnosis for skull base osteomyelitis, MRI or CT should be used to rule out other conditions, especially malignancy (9). In the cranial MR signal changes in the skull base bone marrow take place as the loss of cortical definition and contrastholding appearance in the affected regions.…”

Section: Discussionmentioning

confidence: 99%

Skull Base Osteomyelitis Presenting with Facial Paralysis, Low Cranial Nerve Palsies and Bilateral Carotid Involvement: A Case Report

Atmaca¹,

Yeşilot²,

Çoban³

2015

tnd

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Skull base osteomyelitis (SBO) typically presents with severe otalgia and unilateral otorrhea in immune-compromised, particularly in elderly diabetic patients. Skull base osteomyelitis usually presents with external otitis but it can also occur as a complication of acute otitis media and mastoiditis. Complications of SBO are venous sinus thrombosis, meningitis, abscess, cranial neuropathies and carotid invasion with or without ischemic stroke. Here we report a case with SBO presenting with facial paralysis, lower cranial nerve palsies and bilateral carotid involvement which occurred following sore throat and bilateral otalgia. Kafa tabanı osteomiyeliti (KTO) tipik olarak immün sistemi baskılanmış kişilerde, özellikle yaşlı diyabetik hastalarda şiddetli otalji ve tek taraflı otore ile kendini gösterir. Genelde eksternal otitle birliktedir ama akut otitis media ve mastoiditin komplikasyonu olarak da görülebilir. Kafa tabanı osteomiyelitinin komplikasyonları arasında sinüs ven trombozu, menenjit, abse, kranyal nöropatiler, iskemik infarktların eşlik ettiği veya etmediği karotis invazyonu bulunmaktadır. Bu olgu sunumunda boğaz ve iki yanlı kulak ağrısı sonrası gelişen fasyal paralizi, alt kranyal sinir felçleri ve iki yanlı karotis tutulumu ile kendini gösteren bir kafa tabanı osteomiyeliti olgusu bildirilmektedir. (Türk Nöroloji Dergisi 2015; 21:27-30) Anah tar Ke li me ler: Kafa tabanı osteomiyeliti, eksternal otit, psödomonas aeruginosa, internal karotis arter Çıkar Çatışması: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemiştir.

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Skull base osteomyelitis: current microbiology and management

Abstract: Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

Cited by 37 publications

References 25 publications

Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

Skull Base Osteomyelitis Presenting with Facial Paralysis, Low Cranial Nerve Palsies and Bilateral Carotid Involvement: A Case Report

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