Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation.
OBJECTIVE
We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence.


METHODS
Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement.


RESULTS
Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed.


CONCLUSIONS
There is high morbidity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.
Singh
Amar
A
Department of Otorhinolaryngology-Head and Neck Surgery and Communication Disorder, Al Nahdha Hospital, Muscat, Sultanate of Oman. ankit@omantel.net.om
Al Khabori
Mazin
M
Hyder
M Jamil
MJ
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017809:Fatal Outcome; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010032:Otitis Externa / Q000150:complications*; D011877:Radionuclide Imaging; D012008:Recurrence; D019291:Skull Base; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents