Pseudomonas cervical osteomyelitis with retropharyngeal abscess: an unusual complication of otitis media

Abstract

We present the unusual case of a 54-year-old diabetic man with chronic suppurative otitis media, presenting with cervical osteomyelitis and retropharyngeal abscess. This was treated with decompression, debridement and fusion from C2 to C4 with external halo-frame stabilization. Pseudomonas aeruginosa was cultured from the ear and the osteomyelitis specimen. Exploration of the left ear showed evidence of mucosal disease, with granulations in the middle ear and oedematous mucosa in the mastoid antrum, but no evidence of dural-plate dehiscence. Haematogenous spread probably led to cervical osteomyelitis and retropharyngeal abscess formation. Cervical osteomyelitis may develop as a rare complication and present as a cause of severe neck pain in patients with otitis media.

Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature

“…The incidence of spinal epidural abscesses has increased due to the increasing prevalence of immunocompromized status and the aging population 30,31) . Moreover, the main source of UCEA is contiguous spread, such as that in the case of otorhinolaryngologic disease and tooth extraction [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Thus, 7 there may be an increasing number of patients with UCEA requiring anterior debridement and 8 stabilization.…”

“…An upper cervical epidural abscess (UCEA) can cause fatal 6 respiratory failure and/or tetraplegia, and emergent surgical intervention is required in patients with 7 progressive limb paralysis 7) . Although the transoral approach is frequently used for the treatment of 8 UCEA [8][9][10][11][12][13][14][15][16][17] , it may be inappropriate if a wide operative field and anterior stabilization are required [18][19][20][21][22][23][24][25][26][27] . For such patients, the transoral mandibular tongue-splitting approach may be useful, but it has not been used for the treatment of UCEA due to its invasiveness and possible complications [18][19][20][21][22][23][24][25][26][27] .…”

Subdural empyema, retropharyngeal and parapharyngeal space abscess: Unusual complications of chronic otitis media

“…Retropharyngeal abscess, as a result of acute otitis media, is described together with cervical vertebral osteomyelitis through direct spread down the skull base 9,10 . Retropharyngeal abscess, as a result of acute otitis media, is described together with cervical vertebral osteomyelitis through direct spread down the skull base 9,10 .…”

Chronic retropharyngeal abscess

“…But in a study, it's a method of choice for only 22% 8 . For many, neck films are used for screening purposes only [9][10] . CT/ MRI scan is the investigation of choice as it provides additional details 5 .…”