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Central skull base osteomyelitis

An emerging clinical entity

Authors

  • Andrew K. Johnson MD,

    1. Department of Otolaryngology–Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
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  • Pete S. Batra MD, FACS

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
    • Send correspondence to Pete S. Batra, MD, FACS, Associate Professor, Co-Director, Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390. E-mail: pete.batra@utsouthwestern.edu

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  • Presented at the spring ARS meeting at COSM, Orlando, Florida, April 10–14, 2013.

  • Dr. Batra has received research grants from ARS and Medtronic, and is a consultant for Medtronic.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Skull base osteomyelitis (SBO) most commonly results as a complication of otitis externa in diabetic patients. Central or atypical presentations, unrelated to aural pathology, have been documented, though restricted to small patient series or case reports. The current study systematically analyzed the literature to construct the clinical profile of this rare entity.

Study Design

Systematic review of case series.

Methods

The MEDLINE database was searched for all published cases of central SBO. Four additional cases were included from the University of Texas Southwestern Medical Center. Statistical analysis was performed to identify trends affecting overall outcomes or differences in treatment.

Results

A total of 42 cases were included with mean age of 52 years and male:female ratio of 2.2:1. The most common presenting symptoms were headaches and cranial nerve palsies, including VI (31%), IX (29%), and X (29%). Staphylococcus aureus (21%) and Pseudomonas aeruginosa (19%) were the two most common causative pathogens. The mean duration of antimicrobial therapy was 21 weeks, with 55% requiring intravenous antibiotics for a mean duration of 6.9 weeks. Twenty of 42 patients (48%) received surgical biopsy for diagnosis, whereas 18 patients (43%) required adjunct surgical debridement. Women were more likely than men to require multiple courses of therapy (46% vs. 7%, P = .01). The overall mortality was 9.5%, with an additional 31% experiencing residual neurological dysfunction.

Conclusions

Osteomyelitis of the central skull base poses significant challenges for timely and accurate diagnosis. Aggressive management with antimicrobials, coupled with surgical debridement in select cases, may avoid serious neurologic morbidity and mortality.

Level of Evidence

NA Laryngoscope, 124:1083–1087, 2014

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