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Skull base osteomyelitis: current microbiology and management

Published online by Cambridge University Press:  22 October 2012

P M Spielmann ,
R Yu  and
M Neeff
P M Spielmann*
Affiliation:
Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand
R Yu
Affiliation:
Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand
M Neeff
Affiliation:
Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand
*
Address for correspondence: Dr P M Spielmann, Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand E-mail: patrickspielmann@nhs.net
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Abstract

Introduction:

Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms.

Methods:

A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined.

Results:

Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients’ treatment algorithm is presented.

Conclusion:

Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

Keywords

Otitis ExternaOuter EarEar CanalPseudomonas InfectionsFacial PalsyInfection

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Supplement S1 , January 2013 , pp. S8 - S12
Copyright
Copyright © JLO (1984) Limited 2012

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