Skull base osteomyelitis: a diagnostic and therapeutic dilemma

Objective: Skull base osteomyelitis (SBO) is an unusual complication of malignant otitis externa (MOE), a potentially life-threatening invasive infection defined as “malignant” due to the high mortality rate it is associated with. It must be diagnosed and treated promptly. The aim of this study was to analyse various aspects of SBO diagnosis and treatment in light of the literature and our personal experience. Materials and methods: We conducted a retrospective analysis on six cases of SBO diagnosed and treated at the ENT Department of Padua University between January 2011 and April 2015. All patients were elderly and diabetic. They all had MOE and experienced hearing loss, otalgia, otorrhea, headache and vertigo. They showed signs of multiple cranial nerve involvement and erosion of bony skull base profiles, which prompted the diagnosis of SBO. Cases of MOE with no skull base involvement were excluded from the study. Results: One patient died of the disease. The others were all discharged with complete or partial recovery from cranial nerve palsy, a normalized inflammatory index, a good glycaemic control and no clinical symptoms. The average followup was 13 months (range: one to 21 months). Conclusion: Diagnostic delays are common for MOE and SBO, would could be contained or prevented by improving physicians’ awareness of these conditions. Suspected cases should be promptly referred for radiological examination and histology where feasible. Left untreated, the condition carries high morbidity and mortality rates, so its management should be aggressive and timely