Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-25T11:05:34.376Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
2Holder, CD, Gurucharri, M, Bartels, LJ, Colman, MF. Malignant external otitis with optic neuritis. Laryngoscope 1986;96:1021–3CrossRefGoogle ScholarPubMed
3Rubin, J, Yu, VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988;85:391–8CrossRefGoogle ScholarPubMed
4Gordon, G, Giddings, NA. Invasive otitis externa due to Aspergillus species: case report and review. Clin Infect Dis 1994;19:866–70CrossRefGoogle ScholarPubMed
5Chandler, JR. Malignant external otitis: further considerations. Ann Otol Rhinol Laryngol 1977;86:417–28CrossRefGoogle ScholarPubMed
6Slattery, WH, Brackmann, DE. Skull base osteomyelitis: malignant external otitis. Otolaryngol Clin North Am 1996;29:795–806CrossRefGoogle ScholarPubMed
7Mani, N, Sudhoff, H, Rajagopal, S, Moffat, D, Axon, PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007;117:907–10CrossRefGoogle ScholarPubMed
8Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23CrossRefGoogle ScholarPubMed
9Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
102006 Census series: Immigration and Ethnicity in the Auckland region. In: http://www.arc.govt.nz/albany/fms/main/Documents/Auckland/Population%20and%20stats/Immigration%20and%20Ethnicity%20in%20the%20Auckland%20region%202006.pdf [30 April 2012]Google Scholar
11Djalilian, HR, Shamloo, B, Thakkar, KH, Najme-Rahim, M. Treatment of culture-negative skull base osteomyelitis. Otol Neurotol 2006;27:250–5CrossRefGoogle ScholarPubMed
12Ali, T, Meade, K, Anari, S, ElBadawey, MR, Zammit-Maempel, I. Malignant otitis externa: case series. J Laryngol Otol 2010;124:846–51CrossRefGoogle ScholarPubMed
13Babiatzki, A, Sade, J. Malignant external otitis. J Laryngol Otol 1987;101:205–10CrossRefGoogle ScholarPubMed
14Menachof, MR, Jackler, RK. Otogenic skull base osteomyelitis caused by invasive fungal infection. Otolaryngol Head Neck Surg 1990;102:285–9CrossRefGoogle ScholarPubMed
15Barrow, HN, Levenson, MJ. Necrotizing ‘malignant’ external otitis caused by Staphylococcus epidermidis. Arch Otolaryngol Head Neck Surg 1992;118:94–6CrossRefGoogle ScholarPubMed
16Cunningham, M, Yu, VL, Turner, J, Curtin, H. Necrotizing otitis externa due to Aspergillus in an immunocompetent patient. Arch Otolaryngol Head Neck Surg 1988;114:554–6CrossRefGoogle Scholar
17Gehanno, P. Ciprofloxacin in the treatment of malignant external otitis. Chemotherapy 1994;40:35–40CrossRefGoogle ScholarPubMed
18Shupak, A, Greenburg, E, Hardoff, R, Gordon, C, Melamed, Y, Meyer, WS. Hyperbaric oxygenation for necrotizing (malignant) otitis externa. Arch Otolaryngol Head Neck Surg 1989;115:1470–5CrossRefGoogle ScholarPubMed
19Phillips, JS, Jones, SEM. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database Syst Rev 2005;(2):CD004617CrossRefGoogle ScholarPubMed
20Grandis, JR, Branstetter, BF, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4:34–9CrossRefGoogle Scholar
21Soudry, E, Joshua, BZ, Sulkes, J, Nageris, BI. Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 2007;133:1002–4CrossRefGoogle ScholarPubMed
22Grandis, JR, Curton, HD, Yu, VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196:499–504CrossRefGoogle Scholar
23Okapala, NCE, Siraj, QH, Nilssen, E, Pringle, M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005;119:71–5CrossRefGoogle Scholar