Clinical profiling and management outcome of atypical skull base osteomyelitis

Singh, Urvashi; Venkitachalam, Shruti; Chinnusamy, Rayappa

doi:10.1080/02688697.2019.1699905

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…Chandler et al reported four cases, while Singh et al published 10 patients with atypical SBO diagnosed on contrast-enhanced MRI showing lytic lesion involving clivus, sphenoid, and petrous bones in the absence of malignant otitis externa. 3 20 Literature recommends aggressive treatment for minimum of 6 to 20 weeks due to poor vascularity of target area and impaired immune response associated with underlying comorbidities. 11 12 Mortality rate noted in our cohort was 33% as compared with 10 to 20% in previous literature.…”

Section: Discussionmentioning

confidence: 99%

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Saxena

Paul

Singh

et al. 2021

JNRP

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Objective Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Materials and Methods Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Statistical Analysis Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's t-test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. Results We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection (Aspergillus) was associated with anterior SBO (10%), while bacteria (Pseudomonas) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies (p = 0.04), suboptimal duration of medical treatment (p = 0.03), surgical intervention during clinical course (p = 0.02), and development of intracranial or extracranial complications (p = 0.03) were the predictors of mortality. Conclusion Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.

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Section: Discussionmentioning

confidence: 99%

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Saxena

Paul

Singh

et al. 2021

JNRP

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“…The atypical form can be revealed by unremitting headaches but the absence of localized and evident infection poses diagnosis challenges [3,8]. Indeed, on Singh et al [9] study about 10 patients treated for atypical SBO, the main clinical symptom was a vague dull headache with one or more cranial nerve palsy(s) while the radiological examination showed clival involvement in all the cases, concluding that the suspicion of atypical SBO should be raised in front of non-specific symptoms of headaches with cranial nerve palsy even with no evident signs of otological or rhinological infections especially in immune-compromised patients.…”

Section: Discussionmentioning

confidence: 99%

Extensive skull base osteomyelitis, devastating complication of otitis externa: A case report and review of the literature

Bouhmadi¹,

Loudghiri²,

Oukessou³

et al. 2021

The GMS

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Skull base osteomyelitis (SBO), also referred to as malignant otitis externa (MOE) in its typical form, is usually a complication of otitis externa and severe uncommon and life-threatening condition requiring early diagnosis and long-term treatment in order to avoid its neurologic sequelae. We report the case of 69 years old female with a history of uncontrolled type 2 diabetes, who presented refractory and chronic right-sided purulent otorrhea with temporal headaches for 6 months, treated with no improvement by multiple attempts of ambulatory empiric therapy. After the appearance of grade III facial palsy and painful swelling in the right periorbital and zygomatic areas, the patient consulted in our department where a CT scan showed massive cortical and trabecular destruction of the right petrous bone and the mastoid extended to the lateral orbital wall, the zygomatic arch and the greater sphenoid wing realising extensive osteomyelitis of the skull base and the lateral face. The treatment was started immediately based on intravenous broad-spectrum antibiotics. Despite aggressive long-term treatment, the patient passed away, underlying the increased SBO morbidity and mortality secondary to delayed diagnosis.

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“…In the case of initially negative microbiologic studies, further examination including fungi or slow-growing pathogens should always be performed, ideally using new molecular techniques available in other fields to optimize diagnosis and treatment with new drugs. 5,17,18 Moreover, in fungal MOE, positive bacterial cultures can occur due to previous therapy causing an alteration in the existing flora and delaying the diagnosis of a fungal etiology. 16 Moreover, fungal MOE usually occurs in high-risk patients affected by diabetes, congenital or acquired immune-deficiencies, malignancies, chronic renal failure, and users of prolonged steroid or antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,[20][21][22][23][24] Computed tomography describes bone details, whereas MRI enriched with diffusion-weighted intensity sequences identifies soft tissue abnormalities. [22][23][24] Recently, some authors have shown that 18 F-FDG (18F-fluorodeoxyglucose) positron emission tomography can be considered a good diagnostic and therapy monitoring tool for SBO. 25 Coronal and axial Turbo Spin Echo (TSE) T2-weighted magnetic resonance imaging (A and B) showed asymmetric nasopharynx and parapharyngeal space with soft tissue swelling on the right side (white arrow) and opacification of the mastoid air cells (B).…”

Section: Discussionmentioning

confidence: 99%

“…13 In addition to empirical antimicrobial therapy, supportive treatment should also include strict glycemic control, correction of electrolyte imbalance, and immunocompetency recovery when possible, along with analgesics for pain control. 6,18 Some authors have also investigated hyperbaric oxygen as a promising adjunct therapy, demonstrating a higher rate and speed of recovery than those treated with antimicrobials alone. 5,27 A severe and life-threatening complication of MOE, especially fungal MOE, is infection of the intracranial arteries as this can lead to the formation of pseudoaneurysms; these represent 0.7% to 4% of all cerebral aneurysms.…”

Section: Smentioning

confidence: 99%

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Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature

et al. 2020

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Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol.

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Clinical profiling and management outcome of atypical skull base osteomyelitis

Cited by 8 publications

References 11 publications

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Extensive skull base osteomyelitis, devastating complication of otitis externa: A case report and review of the literature

Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature

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