[Osteomyelitis of the skull base due to otologic or sinus infections. 5 cases].
BACKGROUND
Skull base osteomyelitis is an uncommon but severe condition generally secondary to necrotizing otitis externa. The aim of this study was to determine the patients demographics, clinical and radiological findings, and outcomes of this condition.


METHODS
We prospectively follow 5 patients with a diagnosis of skull base osteomyelitis between 2004 and 2005. Clinical, biologic and imaging data were collected, and also follow-up during treatment.


RESULTS
The five patients were men and the average age at presentation was 75 years (63-89). All except one had a previous diabetes mellitus, with a more or less recent clinical story of otitis externa. All of them suffered of headaches and cranial nerve(s) deficits, particularly facial nerve. Diagnosis was made on MRI with gadolinium injection and fat saturation, and Pseudomonas aeruginosa identified as pathogen in all cases. One patient deceased of cranial nerves palsy complication. In 4 cases we found previously a too short or non adapted treatment of necrotizing otitis externa.


CONCLUSIONS
In the setting of headache, cranial nerves deficit and abnormal skull base imaging on MRI with Fat sat, osteomyelitis should be consider as the likely diagnosis. This complication should be avoided by optimal management of necrotizing otitis externa.
Bouccara
D
D
Service d'ORL, hôpital Beaujon, APHP, université Paris-VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France. didier.bouccara@bjn.ap-hop-paris.fr
Simon-Blancal
V
V
Rodallec
M
M
Cyna-Gorse
F
F
Mosnier
I
I
Fantin
B
B
Sterkers
O
O
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D048909:Diabetes Complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015523:Maxillary Sinusitis / Q000150:complications; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010032:Otitis Externa / Q000150:complications*; D011552:Pseudomonas Infections / Q000150:complications*; D011877:Radionuclide Imaging / Q000379:methods; D019291:Skull Base; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents