title: The role of the otorhinolaryngologist in the management of central skull base osteomyelitis.
abstract: BACKGROUND
  Skull base osteomyelitis (SBO) typically evolves as a complication of external otitis in diabetic patients and involves the temporal bone. Central SBO (CSBO) mainly involves the sphenoid or occipital bones without coexisting external otitis. We characterized a group of patients with CSBO. The endoscopic nasopharyngeal and clival biopsy technique is described.
  
  
  METHODS
  Medical records of patients diagnosed as having SBO were retrospectively analyzed (from 2001 to 2006). Patients' symptoms and signs, laboratory findings, imaging characteristics, endoscopic clival and periclival histopathology results, treatment, and outcome were retrieved.
  
  
  RESULTS
  Of 20 patients with SBO, 6 patients without external otitis were studied (age range, 54-76 years; 5 men; mean follow-up, 21 months). All patients suffered from unilateral headache, three of six patients had serous otitis media (SOM), three of six patients had cranial nerve (CN) palsies, and five of six patients had elevated acute-phase reactants. Computed tomography (CT) findings were clival cortical bone erosion and adjacent soft tissue swelling. Magnetic resonance (MR) findings were texture changes and enhancement of the involved bones and soft tissues. Biopsy specimens revealed chronic inflammation. All six patients were treated with antibiotics for 3-6 months. Headache disappeared in five of six patients, SOM resolved in two of three patients, and CN palsies partially recovered in two of three patients. Imaging findings improved in five of six patients.
  
  
  CONCLUSIONS
  CSBO may mimic malignancy and represents a diagnostic challenge. Typical clinical picture and imaging findings together with a positive response to ciprofloxacin may suffice to establish the diagnosis and obviate the need for biopsies. When in doubt, nasopharyngeal and clival biopsies are performed to rule out malignancy.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty ofMedicine, Tel-Aviv University, Tel-Aviv, Israel. orencavel@gmail.com
authors.forename: Oren
authors.initials: O
authors.lastname: Cavel
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Yoram
authors.initials: Y
authors.lastname: Segev
authors.forename: Daniel
authors.initials: D
authors.lastname: Zik
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Roee
authors.initials: R
authors.lastname: Landsberg
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000473:pathology; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D010031:Otitis / Q000150:complications*; D010036:Otolaryngology; D010038:Otorhinolaryngologic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging / Q000473:pathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed