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Central skull base osteomyelitis: new insights and implications for diagnosis and treatment

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Abstract

Central skull base osteomyelitis (SBO) is a life-threatening disease originating from ear and from sinonasal infections. The intention of this study was to evaluate contemporary trends in etiology, diagnosis, management, and outcome of SBO and to draw the clinician’s attention on this probably underestimated disease. Over a 6-year period we performed this systematic study in an academic quaternary medical care and skull base center including 20 patients (mean age 63.7 years) with central SBO, which is one of the largest series from a single center. In contrast to previous studies we explicitly excluded infections limited to malignant external otitis only but did not restrict central SBO to conditions unrelated to aural pathology. Fifteen patients had otogenic and five sinugenic SBO; four patients had fungal or mixed fungal infections. Pre-existing illnesses altering bone vascularization were detected in 70 % of the patients and had a negative effect on the improvement of cranial nerve palsies that were found in 14 patients. In relation, patients with otogenic SBO more often had local and systemic predisposing factors. Contrary to previous studies 16 patients (80 %) underwent surgical therapy and none of our patients died. A meta-analysis of five recent studies was done and compared with our own data and two previous meta-analyses. The present study highlights several important aspects with major implications for diagnosis and treatment of SBO that have not been adequately addressed as yet. In contrast to the restrictive attitude towards surgery in literature we recommend early and radical operative treatment to reduce its mortality.

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References

  1. Blyth CC, Gomes L, Sorrell TC, da Cruz M, Sud A, Chen SC (2011) Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect 17:306–311

    Article  CAS  PubMed  Google Scholar 

  2. Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouracei R (2008) Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol 29:666–672

    Article  CAS  PubMed  Google Scholar 

  3. Magliulo G, Varacalli S, Ciofalo A (2000) Osteomyelitis of the skull base with atypical onset and evolution. Ann Otol Rhinol Laryngol 109:326–330

    Article  CAS  PubMed  Google Scholar 

  4. Singh A, Al Khabori M, Hyder J (2005) Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg 133:121–125

    Article  PubMed  Google Scholar 

  5. Patmore H, Jebreel A, Uppal S, Raine CH, McWhinney P (2010) Skull base infection presenting with multiple lower cranial nerve palsies. Am J Otolaryngol 31:376–380

    Article  PubMed  Google Scholar 

  6. Alva B, Prasat KC, Prasat SC, Pallavi S (2009) Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa. J Laryngol Otol 123:1288–1291

    Article  CAS  PubMed  Google Scholar 

  7. Johnson AK, Batra PS (2014) Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope 124:1083–1087

    Article  PubMed  Google Scholar 

  8. Rothholtz VS, Lee AD, Shamloo B, Bazargan M, Pan D, Djalilian HR (2008) Skull base osteomyelitis: the effect of comorbid disease on hospitalization. Laryngoscope 118:1917–1924

    Article  PubMed  Google Scholar 

  9. Clark MP, Pretorius PM, Byren I, Milford CA (2009) Central or atypical skull base osteomyleitis: diagnosis and treatment. Skull Base 19:247–254

    Article  PubMed Central  PubMed  Google Scholar 

  10. Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R (2007) The role of otolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol 21:281–285

    Article  PubMed  Google Scholar 

  11. Djalilian HR, Shamloo B, Thakkar KH, Najme-Rahim M (2006) Treatment of culutre-negative skull base osteomyelitis. Otol Neurotol 27:250–255

    Article  PubMed  Google Scholar 

  12. Sandner A, Henze D, Neumann K, Kösling S (2009) Value of hyperbaric oxygen in the treatment of advanced skull base osteomyelitis. Laryngorhinootologie 88:641–646

    Article  CAS  PubMed  Google Scholar 

  13. Toulmouche MA (1938) Observations d’Otorrhee Cerebrale Suivis des Reflexions. Gaz Med Paris 6:422

    Google Scholar 

  14. Meltzer PE, Kelemen G (1959) Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 69:1300–1316

    Article  Google Scholar 

  15. Bernheim J, Sade J (1989) Histopathology of the soft parts in 50 patients with malignant external otitis. J Laryngol Otol 103:366–368

    Article  CAS  PubMed  Google Scholar 

  16. Sreepada GS, Kwartler JA (2003) Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 11:316–321

    Article  PubMed  Google Scholar 

  17. Chen CN, Chen YS, Yeh TH, HSU CJ (2010) Outcomes of malignant externa otitis: survival versus mortalitiy. Acta Otolaryngol 130:89–94

    Article  PubMed  Google Scholar 

  18. Ganhewa AD, Kuthubutheen J (2013) A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient. BMJ Case Rep. doi:10.1136/bcr-2012-007183

    PubMed Central  PubMed  Google Scholar 

  19. Adams A, Offiah C (2012) Central skull base osteomyelitis as a complication of necrotizing otitis externa: imaging findings, complications, and challenges of diagnosis. Clin Radiol 67:e7–e16

    Article  CAS  PubMed  Google Scholar 

  20. Severino M, Liyanage S, Novelli V, Cheesborough B, Saunders D, Gunny R, Rossi A (2012) Skull base osteomyelitis and potential cerebrovascular complications in children. Pediatr Radiol 42:867–874

    Article  PubMed  Google Scholar 

  21. Rubin Grandis J, Brandstetter BF, Yu VL (2004) The changing face of malignant external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 4:34–39

    Article  PubMed  Google Scholar 

  22. Geerlings SE, Hoepelman AI (1999) Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 26:259–265

    Article  CAS  PubMed  Google Scholar 

  23. Levenson MJ, Parisier SC, Dolitsky J, Bindra G (1991) Ciprofloxacin: drug of choice in the treatment of malignant external otitis. Laryngoscope 101:821–824

    Article  CAS  PubMed  Google Scholar 

  24. Berenholz L, Katzenell U, Harell M (2002) Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 112:1619–1622

    Article  CAS  PubMed  Google Scholar 

  25. Grobman LR, Ganz W, Casiano R, Goldberg S (1989) Atypical osteomyelitis of the skull base. Laryngoscope 99:671–676

    Article  CAS  PubMed  Google Scholar 

  26. Kountakis SE, Kemper JV Jr, Chang CY, DiMaio DJ, Stiernberg CM (1997) Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 18:19–22

    Article  CAS  PubMed  Google Scholar 

  27. Amorosa L, Modugno GC, Pirodda A (1996) Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 521:3–16

    Article  CAS  PubMed  Google Scholar 

  28. Malone DG, O‘Boynick PL, Ziegler DK, Batnitzky S, Hubble JP, Holladay FP (1992) Osteomyelitis of the skull base. Neurosurgery 30:426–431

    Article  CAS  PubMed  Google Scholar 

  29. Tisch M, Lorenz KJ, Harm M, Lampl M, Maier H (2003) The treatment of necrotizing otitis externa with a combination of surgery, antibiotics, specific immunoglobulins and hyperbaric oxygen therapy. Results of the Ulm Treatment Concept. HNO 51:315–320

    Article  CAS  PubMed  Google Scholar 

  30. Chandler JR (1972) Pathogenesis and treatment of facial paralysis in malignant external otitis. Ann Otol Rhinol Laryngol 81:648–658

    Article  CAS  PubMed  Google Scholar 

  31. Mani N, Sudhoff H, Rajagopal S, Moffat D, Axon PR (2007) Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 117:907–910

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank all members of the Interdisciplinary Skull Base Centre as well as the Department of Internal Medicine (Section Clinical Infectiology), the Institute of Medical Microbiology and Hygiene, and the Institute of Pathology, University of Freiburg (Germany), for excellent interdisciplinary cooperation.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany

    Gerd J. Ridder, Christine Breunig & Jens Pfeiffer

  2. Department of Neurosurgery, University of Freiburg, Freiburg, Germany

    Jan Kaminsky

  3. Interdisciplinary Skull Base Centre, University of Freiburg, Freiburg, Germany

    Gerd J. Ridder, Christine Breunig, Jan Kaminsky & Jens Pfeiffer

Authors
  1. Gerd J. Ridder
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  2. Christine Breunig
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  4. Jens Pfeiffer
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Correspondence to Jens Pfeiffer.

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Ridder, G.J., Breunig, C., Kaminsky, J. et al. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol 272, 1269–1276 (2015). https://doi.org/10.1007/s00405-014-3390-y

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  • DOI: https://doi.org/10.1007/s00405-014-3390-y

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