Otogenic Skull Base Osteomyelitis: Clinical Presentation, Diagnostic and Therapeutic Challenges, and Long-Term Outcomes from a Single Tertiary Centre
Öz
Objective: This study assesses the demographic and clinical characteristics, diagnostic and treatment methods, and long-term outcomes of patients diagnosed with and treated for otogenic skull base osteomyelitis (OSBO). Second, we attempted to determine the effect of hyperbaric oxygen treatment (HBOT) on the treatment of OSBO.
Material and Methods: We conducted a retrospective analysis of the medical records of 17 patients hospitalised with an OSBO diagnosis in our clinic from 2017 to 2024. We reviewed the demographic infor mation, symptoms, laboratory results, imaging and treatment methods, length of hospital stay, associated complications, and follow-up periods.
Results: Nearly all patients, except one, were elderly males (mean age: 68.9 years; range: 57–81 years). All patients had type 2 DM, with 88.2% (n=15) having multiple comorbidities, including hypertension and coronary artery disease. The most common symptoms were otalgia, hearing loss, and otorrhea, with cranial nerve (CN) palsy observed in 70.6% (n=12). Five patients experienced single CN involvement (CN VII in three, CN XII in one, and CN VI in one), while seven had multiple CN palsy. The mean length of hospital stay was 45 days (range: 21–80 days). In addition to intravenous antibiotic therapy, hyperbaric oxygen therapy (HBOT) was administered to 52.9% (n=9). In the HBOT group, no significant reduction was observed in morbidity or length of hospital stay. During the 7-year follow-up period, mortality occurred in 17.6% (n=3).
Conclusion: OSBO should be considered as a differential diagnosis in elderly diabetic patients with persistent otalgia and otorrhea who do not respond to empirical antibiotic therapy. Although our study did not reveal any significant effects of HBOT on OSBO prognosis or length of hospital stay, randomised controlled trials are needed to assess its potential benefits.
Anahtar Kelimeler
Skull base osteomyelitis temporal bone osteomyelitis malignant otitis externa hyperbaric oxygen therapy cranial nerve palsy diabetes mellitus
Kaynakça
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- Murray ME, Britton J. Osteomyelitis of the skull base: the role of high resolution CT in diagnosis. Clin Radiol 1994;49(6):408-11. google scholar
- Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196(2):499-504. google scholar
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Öz
Kaynakça
- Meltzer PE, Keleman G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;569:1300-16. google scholar
- Bernheim J, Sade J. Histopathology of the soft parts in 50 patients with malignant external otitis. J Laryngol Otol 1989;103(4):366-68. google scholar
- Sreepada GS, Kwartler JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 2003;11(5):316-23. google scholar
- Chandler JR. Malignant external otitis. Laryngoscope 1968;78(8):1257-94. google scholar
- Rothholtz VS, Lee AD, Shamloo B, Bazargan M, Pan D, Djalilian HR. Skull base osteomyelitis: the effect of comorbid disease on hospitalization. Laryngoscope 2008;118(11):1917-24. google scholar
- Slattery WH 3rd, Brackmann DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am 1996;29(5):795-806. google scholar
- Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988;85(3):391-8. google scholar
- Rubin Grandis J, Branstetter BF 4th, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4(1):34-9. google scholar
- Mortazavi MM, Khan MA, Quadri SA, Suriya SS, Fahimdanesh KM, Fard SA, et al. Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies. World Neurosurg 2018;111:142-153. google scholar
- Mani N, Sudhoff H, Rajagopal S, Moffat D, Axon PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007;117(5):907-10. google scholar
- Damiani JM, Damiani KK, Kinney SE. Malignant external otitis with multiple cranial nerve involvement. Am J Otol 1979;1(2):115-20. google scholar
- Seabold JE, Simonson TM, Weber PC, Thompson BH, Harris KG, Rezai K, et al. Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology 1995;196(3):779-88. google scholar
- Sokotowski J, Lachowska M, Karchier E, Bartoszewicz R, Niemczyk K. Skull base osteomyelitis: factors implicating clinical outcome. Acta Neurol Belg 2019;119(3):431-7. google scholar
- Khan MA, Quadri SAQ, Kazmi AS, Kwatra V, Ramachandran A, Gustin A, et al. A Comprehensive Review of Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges among Various Presentations. Asian J Neurosurg 2018;13(4):959-70. google scholar
- Le Clerc N, Verillaud B, Duet M, Guichard JP, Herman P, Kania R. Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope 2014;124(9):2013-6. google scholar
- Takata J, Hopkins M, Alexander V, Bannister O, Dalton L, Harrison L, et al. Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research. Clin Otolaryngol 2023;48(3):381-94. google scholar
- Davis JC, Gates GA, Lerner C, Davis MG Jr, Mader JT, Dinesman A. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg 1992;118(1):89-93. google scholar
- Narozny W, Kuczkowski J, Stankiewicz C, Kot J, Mikaszewski B, Przewozny T. Value of hyperbaric oxygen in bacterial and fungal malignant external otitis treatment. Eur Arch Otorhinolaryngol 2006;263(7):680-4. google scholar
- Amaro CE, Espiney R, Radu L, Guerreiro F. Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre. Eur Arch Otorhinolaryngol 2019;276(7):1881-7. google scholar
- Özer F, Pamuk AE, Atay G, Parlak Ş, Yücel T. Skull base osteomyelitis: Comprehensive analysis and a new clinicoradiological classification system. Auris Nasus Larynx 2021;48(5):999-1006. google scholar
- Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouraei R. Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol 2008;29(5):666-72. google scholar
- Stokkel MP, Boot CN, van Eck-Smit BL. SPECT gallium scintigraphy in malignant external otitis: initial staging and follow-up. Case reports. Laryngoscope 1996;106(3 Pt 1):338-40. google scholar
- Murray ME, Britton J. Osteomyelitis of the skull base: the role of high resolution CT in diagnosis. Clin Radiol 1994;49(6):408-11. google scholar
- Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196(2):499-504. google scholar
- Amorosa L, Modugno GC, Pirodda A. Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 1996;521:3-16. google scholar
- Weaver LK. Hyperbaric oxygen therapy for carbon monoxide poisoning. Undersea Hyperb Med 2014;41(4):339-54. google scholar
- Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment [published correction appears in Diving Hyperb Med 2017;47(2):131-132.]. Diving Hyperb Med 2017;47(1):24-32. google scholar
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kulak Burun Boğaz |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2025 |
| Gönderilme Tarihi | 16 Aralık 2024 |
| Kabul Tarihi | 14 Ocak 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 35 Sayı: 1 |
