ABSTRACT
Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.
Subject(s)
Humans , Otitis Externa/therapy , Skull Base/pathology , Ear Canal/pathology , HeadABSTRACT
Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.
Subject(s)
Humans , Otitis Externa/diagnosis , Skull Base , Osteomyelitis/complications , Anti-Bacterial Agents/therapeutic use , Diagnosis, DifferentialABSTRACT
BACKGROUND AND OBJECTIVES: Skull base osteomyelitis (SBO) typically evolves as a complication of malignant otitis externa (MOE) in diabetic patients and involves the temporal bone. Central SBO (CSBO), which mainly involves the sphenoid or occipital bones, has clinicaland radiological characteristics similar to those of SBO but without coexisting MOE. We investigated a group of patients with CSBO and studied the clinical course of CSBO. SUBJECTS AND METHOD: Medical records of patients who were diagnosed with CSBO were retrospectively analyzed from 1999 to 2014. RESULTS: Ten patients (mean age; 60.5 years) were identified. There were five males and five females. All patients suffered from headache, and six patients had cranial nerve palsy including oculomotor (20%), abducens (10%), vestibulocochlear (10%), glossopharyngeal (20%), vagus (30%) and hypoglossal (10%) nerve. Patients had underlying diseases including diabetes mellitus (40%), immunosuppression status after liver transplantation (10%) and cardiovascular disease (40%). Four patients received endoscopic biopsy and debridement for diagnostic and curative intent. Patients were treated with intravenous antibiotics for 5.1 weeks in average and oral antibiotics for 17 weeks. Mean follow-up period was 12.4 months and the mortality rate was zero. 40% of patients had residual neurologic deficit. The earliest sign of improving CSBO was headache (mean; 3.1 weeks) and the erythrocyte sedimentation rate was the latest improving sign (mean; 4 months). CONCLUSION: CSBO was diagnostic and therapeutic challenge to the clinicians. The timely diagnosis and long-term antibiotics therapy could avoid a mortality case and minimize the permanent neurologic deficit.
Subject(s)
Female , Humans , Male , Anti-Bacterial Agents , Biopsy , Blood Sedimentation , Cardiovascular Diseases , Cranial Nerve Diseases , Debridement , Diabetes Mellitus , Diagnosis , Follow-Up Studies , Headache , Immunosuppression Therapy , Liver Transplantation , Medical Records , Mortality , Neurologic Manifestations , Occipital Bone , Osteomyelitis , Otitis Externa , Retrospective Studies , Skull Base , Skull , Temporal BoneABSTRACT
Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm. Panoramic, CT, and CBCT revealed bone resorption patterns in the left condyle. Through control of diabetes, continued pharmacological treatment, arthrocentesis, and occlusal stabilization appliance therapy were carried out. The extent of active mouth opening was increased to 45 mm, and pain in the left jaw joint was alleviated. This was a case wherein complications caused by failure to control diabetes induced skull-base osteomyelitis. There is a need for continued discussion about the advantages and disadvantages of arthrocentesis with lavage for patients with skull-base osteomyelitis and other treatment options.
Subject(s)
Aged , Humans , Middle Aged , Bone Resorption , Ear Canal , Jaw , Joints , Mouth , Occipital Bone , Osteomyelitis , Otitis Externa , Rare Diseases , Temporomandibular Joint Disorders , Temporomandibular Joint , Therapeutic IrrigationABSTRACT
Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , C-Reactive Protein/analysis , Cranial Nerve Diseases/complications , Diagnosis, Differential , Enterobacter aerogenes/isolation & purification , Enterobacteriaceae Infections/diagnosis , Lung/pathology , Magnetic Resonance Imaging , Mastoiditis/complications , Osteomyelitis/complications , Pulmonary Embolism/complications , Sinus Thrombosis, Intracranial/complications , Skull Base , Sputum/microbiology , Tomography, X-Ray ComputedABSTRACT
Skull base osteomyelitis is originated from inappropriately treated chronic infections near the skull base. If diagnosis and treatment are delayed, it occasionally causes multiple cranial nerve palsy, with the mortality rate being as high as 60%. Skull base osteomyelitis typically evolves as a complication of external otitis in diabetic patients, so it has been thought as a synonym for malignant external otitis. However, the routes of infection are diverse. We experienced two patients of atypical skull base osteomyelitis after mastoidectomy. It is an unusual complication of mastoidectomy, so we report about these cases.
Subject(s)
Humans , Cranial Nerve Diseases , Osteomyelitis , Otitis Externa , Skull , Skull BaseABSTRACT
Skull base osteomyelitis is a rare but life-threatening complication of inflammation of the ear. The authors present a case of skull base osteomyelitis of unknown etiology in a non-diabetic patient who presented with unilateral posterior neck and occipital headache mimicking cervicogenic headache.