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Aspergillus infections of lateral skull base: a case series

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

While extensive research with accurate classification has been done in mycoses of the paranasal sinuses and anterior skull base, a similar understanding of lateral skull base fungal pathologies is lacking due to relative rarity and diagnostic difficulties. We introduce a series of eleven cases and two different invasive entities of Aspergillus temporal bone diseases—fungal skull base osteomyelitis (SBO)/malignant otitis externa (MOE) and chronic invasive granulomatous fungal disease (CIGFD).

Methodology

A retrospective observational study was conducted at the neuro-otology unit of a tertiary care referral center between July 2017 and November 2022. Diagnosed cases of lateral skull base osteomyelitis with atypical symptoms and lack of response to culture-directed antibiotics were evaluated for fungal origin. Patient data, including history, laboratory findings, serum galactomannan assay, CT and MRI imaging findings, clinical examination findings, and co-morbidities, were analyzed. The treatment course and response were assessed.

Results

A total of 11 cases were included in the study. Of these, 9 were cases of Aspergillus-induced skull base osteomyelitis (SBO) and 2 of Aspergillus-induced chronic invasive granulomatous fungal disease (CIGFD). CIGFD presented with persistent ear discharge and slowly progressive post-aural swelling, while all patients of fungal SBO had lower cranial nerve palsies. CIGFD responded to excision and antifungals, while SBO responded well to conservative anti-fungal treatment.

Conclusion

In cases of lateral SBO not responding to antibiotic therapy, the possibility of fungal etiology should be considered. Aspergillus spp. seems to be the major fungal pathogen.

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Data availability

The data is available with the authors and can be provided on request.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Neurotology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Manjul Muraleedharan, Amit Keshri, Abhishek Dubey, Nazrin Hameed, Kalyana Sundaram Chidambaram, Mohd Aqib & Ravi Sankar Manogaran

  2. Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Ram Nawal Rao

  3. Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Anant Mehrotra, Kuntal Kanti Das & Raj Kumar

Authors
  1. Manjul Muraleedharan
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  2. Amit Keshri
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  3. Ram Nawal Rao
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  4. Anant Mehrotra
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  5. Kuntal Kanti Das
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  8. Kalyana Sundaram Chidambaram
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  9. Mohd Aqib
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  10. Raj Kumar
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  11. Ravi Sankar Manogaran
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Corresponding author

Correspondence to Ravi Sankar Manogaran.

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Ethical approval

The Institute Ethics Committee has approved the study (IEC Code: 2022-148-IP-EXP-50).

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Consent for publication has been obtained from the patients.

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Muraleedharan, M., Keshri, A., Rao, R.N. et al. Aspergillus infections of lateral skull base: a case series. Eur Arch Otorhinolaryngol 281, 1221–1229 (2024). https://doi.org/10.1007/s00405-023-08218-z

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  • DOI: https://doi.org/10.1007/s00405-023-08218-z

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