Skull base osteomyelitis: Comprehensive analysis and a new clinicoradiological classification system

Özer, Furkan; Pamuk, Ahmet Erim; Atay, Gamze; Parlak, Şafak; Yücel, Taşkın

doi:10.1016/j.anl.2021.02.006

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Overall mortality rates range from 8 to 50% with even higher rates when cranial nerve palsies are present [6 & ,13,47,48]. Interestingly, little is reported on treatmentrelated complications which, in our experience, pose a frequent problem and are most commonly nephrotoxic and hepatotoxic or include neutropenia [7]. Inadequate therapy (wrong agent, short duration) might cause recurrence of the disease.…”

Section: Mortality Rate and Complicationsmentioning

confidence: 93%

“…Pseudomonas aeruginosa (PA) has been reported to be the main causative pathogen in SBO with rates ranging from 40% to 90% [7,9 ▪ ,12,18]. Within the last few years, many authors have found an increasing rate of sterile and fungal culture causing prolonged hospitalization [2 ▪▪ ,8].…”

Section: Microbiological and Histopathological Findingsmentioning

confidence: 99%

“…Several authors have reported on disease classification systems to help clinicians estimate prognosis. O ¨zer et al proposed a clinicoradiological grading system based on anatomical involvement in magnetic resonance imaging (MRI) and cranial nerve involvement status [7]. Therefore, SBO diagnosis and follow-up procedures could be standardized.…”

Section: Introductionmentioning

confidence: 99%

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Current management of skull base osteomyelitis

Auinger¹,

Arnoldner²

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients. Recent findings Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases. Summary The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved.

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Section: Mortality Rate and Complicationsmentioning

confidence: 93%

Section: Microbiological and Histopathological Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Current management of skull base osteomyelitis

Auinger¹,

Arnoldner²

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…Nadir görülen görülen KTO'nin yüksek morbidite ve mortalite oranı, doğru antibiyotik ve cerrahi tedavi yaklaşımlarıyla değiştirilebilir. Daha önce yayımlanmış olgu serilerinde olduğu gibi çalışmamızda KTO olguları sıklıkla otojenik kaynaklı (%81) ve yaşlı erkeklerde oluşmaktaydı; en sık risk faktörü hastaların % 87.5'inde tanımlanan diabetes mellitustu (10,11). Literatürde bildirilen otojenik kaynaklı KTO olgu-larında olduğu gibi hastalarda en sık baş ve/veya kulak ağrısının yanı sıra kulak akıntısı şikayeti vardı ve en çok VII.…”

Section: Irdelemeunclassified

“…maktadır. Tanı anında yüksek sedimantasyon, normal lökosit ve CRP değerleri bildiren çalışmaların aksine hastalarımızın %50'ye yakınınında lökosit sayısı ≥10 000 /µl ve bir hasta hariç tümünde CRP değeri normalin üstündeydi (ortalama 9 kat yüksek)(10,15). Hastalarımızın tümünde, taburcu olurken lökosit, CRP ve sedimantasyon değerlerinde azalma saptanırken; ESR değerinde azalma olmayan hastanın 5 ay sonra progresyonla yeniden yatışı olan tek hasta olması manidardı.…”

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Skull Base Osteomyelitis and Long Term Outcome

Başaran¹,

Evlice²,

Benli³

et al. 2021

Klimik Derg

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Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results.

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Serial MRI to monitor the progression of a case of sphenoid bone osteomyelitis in a dog (Canis familiaris)

Aledon,

Mahon,

Staudacher

et al. 2024

Vet Record Case Reports

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A 2‐year‐5‐month‐old, male, neutered, crossbreed dog presented with third eyelid protrusion, right eye exophthalmos and facial hyperaesthesia. Neurological examination was suggestive of a lesion affecting the right optic nerve. Magnetic resonance imaging allowed a presumptive diagnosis of sphenoid bone osteomyelitis, meningitis and right‐sided optic neuritis. The dog was discharged with clindamycin (13 mg/kg/8 h), amoxicillin–clavulanate (25 mg/kg/8 h), gabapentin (10 mg/kg/8 h), paracetamol (15 mg/kg/8 h) and prednisolone (0.5 mg/kg/24 h). Paracetamol, gabapentin and prednisolone were gradually stopped. A 3‐month follow‐up revealed right‐eye blindness. Magnetic resonance imaging showed improvement in changes compatible with osteomyelitis and meningitis resolution, prompting clindamycin cessation. At the 6‐month follow‐up, magnetic resonance imaging indicated only right optic nerve atrophy. Amoxicillin–clavulanate was stopped. There had been no relapses at 12‐month follow‐up. Serial magnetic resonance imaging studies were pivotal in adjusting antibiotic therapy, and instilled confidence for treatment cessation upon lesion resolution. This marked the first use of serial magnetic resonance imaging to modulate sphenoid bone osteomyelitis treatment in dogs.

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Skull base osteomyelitis: Comprehensive analysis and a new clinicoradiological classification system

Cited by 9 publications

References 22 publications

Current management of skull base osteomyelitis

Current management of skull base osteomyelitis

Skull Base Osteomyelitis and Long Term Outcome

Serial MRI to monitor the progression of a case of sphenoid bone osteomyelitis in a dog (Canis familiaris)

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