Treatment of Culture-Negative Skull Base Osteomyelitis

Djalilian, Hamid R.; Shamloo, Bahman; Thakkar, Kunal H.; Najme-Rahim, Mojdeh

doi:10.1097/01.mao.0000181185.26410.80

Cited by 48 publications

(38 citation statements)

References 14 publications

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“…These studies diagnosed MOE based on clinical history, signs and symptoms, biopsy to rule out malignancy, markedly elevated erythrocyte sedimentation rate (ESR), and imaging studies, such as CT and radionuclide (gallium and technetium bone) scanning [8,38]. Previous treatment with oral or topical antibiotics before evaluation and wound culture may be responsible for this scenario, because many patients had already experienced failed response to a short course of oral ciprofloxacin and various topical antibiotic preparations before undergoing otolaryngologic evaluation.…”

Section: Microbiologymentioning

confidence: 99%

“…Previous treatment with oral or topical antibiotics before evaluation and wound culture may be responsible for this scenario, because many patients had already experienced failed response to a short course of oral ciprofloxacin and various topical antibiotic preparations before undergoing otolaryngologic evaluation. Treatment included intravenous ceftazidime (aztreonam for penicillin allergic patients), highdose oral ciprofloxacin (750 mg twice daily), and topical aminoglycosidesteroid drops [8].…”

Section: Microbiologymentioning

confidence: 99%

“…Although only 65% of subjects had diabetes in a recent review of 46 cases of malignant otitis externa [4], the prevalence of diabetes in MOE is more commonly 90% to 100% of patients [2,[5][6][7][8].…”

Section: Epidemiologymentioning

confidence: 99%

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Malignant Otitis Externa

Carfrae

Kesser

2008

Otolaryngologic Clinics of North America

204

244

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Section: Microbiologymentioning

confidence: 99%

Section: Microbiologymentioning

confidence: 99%

See 1 more Smart Citation

Malignant Otitis Externa

Carfrae

Kesser

2008

Otolaryngologic Clinics of North America

204

244

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“…Antibiotics were therefore started empirically. This empirical approach is supported by the recommendations of Djalilian et al [12] for the treatment of culture-negative SBO. Pseudomonas is the common causative organism in SBO but the possibility of polymicrobial infection has to be borne in mind and broad-spectrum antimicrobial therapy should therefore be instituted.…”

Section: Discussionmentioning

confidence: 53%

Central Skull Base Osteomyelitis: Diagnostic Dilemmas and Management Issues

Muranjan

Khadilkar

Wagle

et al. 2015

Indian J Otolaryngol Head Neck Surg

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The aim of this study is to describe the clinical presentation of central skull base osteomyelitis and to discuss the classical imaging findings and various diagnostic and therapeutic challenges faced in the management of this condition. This is a retrospective analysis of inpatient case records, carried out in a multidisciplinary tertiary care hospital. The study subjects included five elderly diabetic patients presenting to the ENT surgeon or neurologist with headache followed by multiple cranial nerve paralysis with no temporal bone involvement in four patients and a past history of otitis externa in one patient. These patients were diagnosed to have an infective pathology of the central skull base detected by imaging and confirmed by biopsy in three. All were treated successfully with antibiotics administered for an average period of 6 weeks. Three patients followed up over 4 years and showed no relapses. One succumbed to other medical co morbidities after 8 months and one diagnosed a month prior is still under follow up. A symptom complex of headache and cranial neuropathies usually raises the suspicion of malignancy. Central skull base osteomyelitis, a relatively uncommon pathology, must also be considered as a possible differential diagnosis despite absence of a definite septic focus. Imaging studies showing bony destruction and adjacent soft tissue involvement should raise the suspicion of this clinical entity. Malignancy needs to be ruled out by biopsy. Early diagnosis and prompt initiation of antibiotics administered for an adequate duration is of paramount importance in successfully treating these patients. A multidisciplinary approach is needed for a successful outcome.

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“…Antimicrobial treatment was continued as long as the scintigraphy remained positive and it was repeated every 6 weeks (9). Intravenous cephalosporin and oral ciprofloxacin combination was shown to be effective in culture negative SBO (25). Recurrence can be seen even 1 year after the treatment (11).…”

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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Treatment of Culture-Negative Skull Base Osteomyelitis

Abstract: The above-described treatment regimen will result in a high cure rate and a short hospitalization period.

Cited by 48 publications

References 14 publications

Malignant Otitis Externa

Malignant Otitis Externa

Central Skull Base Osteomyelitis: Diagnostic Dilemmas and Management Issues

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

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