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J Neurol Surg B Skull Base 2014; 75(05): 324-331
DOI: 10.1055/s-0034-1372468
Original Article

Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

Sampath Chandra Prasad
1   Department of Otolaryngology – Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
,
Kishore Chandra Prasad
1   Department of Otolaryngology – Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
,
Abhijit Kumar
1   Department of Otolaryngology – Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
,
Nikhil Dinaker Thada
1   Department of Otolaryngology – Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
,
Pallavi Rao
2   Department of Radiodiagnosis, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
,
Satyanarayana Chalasani
1   Department of Otolaryngology – Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
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Abstract

Objectives To review the terminology, clinical features, and management of temporal bone osteomyelitis.

Design and Setting Prospective study in a tertiary care center from 2001 to 2008.

Participants Twenty patients visiting the outpatient department diagnosed with osteomyelitis of the temporal bone.

Main Outcome Measures The age, sex, clinical features, cultured organisms, surgical interventions, and classification were analyzed.

Results Of the 20 cases, 2 (10%) were diagnosed as acute otitis media. Eighteen (90%) had chronic otitis media. Nineteen (95%) were classified as medial temporal bone osteomyelitis and one (5%) as lateral temporal osteomyelitis. The most common clinical features were ear discharge (100%), pain (83%), and granulations (100%). Facial nerve palsy was seen in seven cases (35%) and parotid involvement in one case. Ten patients (56%) had diabetes mellitus. The organisms isolated were Pseudomonas aeruginosa (80%) and Staphylococcus aureus (13.33%). Histopathology revealed chronic inflammation in 20 patients (100%) and osteomyelitic bony changes in 14 (70%). Surgical debridement was the most preferred modality of treatment (87%).

Conclusion A new classification of temporal bone osteomyelitis has been proposed. Bacterial cultures must be performed in all patients. Antibiotic therapy is the treatment of choice. Surgical intervention is necessary in the presence of severe pain, complications, refractory cases, or the presence of bony sequestra on radiology.

Keywords

osteomyelitis - temporal bone - diabetes mellitus - malignant external otitis - skull base osteomyelitis

Notes

This paper was presented as a paper at the 28th Politzer Society Meeting, September 28 to October 1, 2011, Athens, Greece, and as a poster at the 14th British Academic Conference in Otolaryngology, July 4–6, 2012, Glasgow, UK.




Publication History

Received: 19 November 2013

Accepted: 23 January 2014

Publication Date:
26 June 2014 (online)

© 2014. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Fitzgerald Jr RH, Brewer NS, Dahlin DC. Squamous-cell carcinoma complicating chronic osteomyelitis. J Bone Joint Surg Am 1976; 58 (08) 1146-1148
    CrossrefPubMedGoogle Scholar
  • 2 Meltzer PE, Kelemen G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959; 169: 1300-1316
    PubMedGoogle Scholar
  • 3 Chandler JR. Malignant external otitis. Laryngoscope 1968; 78 (08) 1257-1294
    CrossrefPubMedGoogle Scholar
  • 4 Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol 2007; 127 (02) 194-205
    CrossrefPubMedGoogle Scholar
  • 5 Chandler JR, Grobman L, Quencer R, Serafini A. Osteomyelitis of the base of the skull. Laryngoscope 1986; 96 (03) 245-251
    CrossrefPubMedGoogle Scholar
  • 6 Dudkiewicz M, Livni G, Kornreich L, Nageris B, Ulanovski D, Raveh E. Acute mastoiditis and osteomyelitis of the temporal bone. Int J Pediatr Otorhinolaryngol 2005; 69 (10) 1399-1405
    CrossrefPubMedGoogle Scholar
  • 7 Ostfeld E, Rubinstein E. Acute gram-negative bacillary infections of middle ear and mastoid. Ann Otol Rhinol Laryngol 1980; 89 (01) 33-36
    CrossrefPubMedGoogle Scholar
  • 8 Chandler JR. Malignant external otitis and osteomyelitis of the base of the skull. Am J Otol 1989; 10 (02) 108-110
    PubMedGoogle Scholar
  • 9 Hern JD, Almeyda J, Thomas DM, Main J, Patel KS. Malignant otitis externa in HIV and AIDS. J Laryngol Otol 1996; 110 (08) 770-775
    CrossrefPubMedGoogle Scholar
  • 10 Walshe P, Cleary M, McConn WR, Walsh M. Malignant otitis externa—a high index of suspicion is still needed for diagnosis. Ir Med J 2002; 95 (01) 14-16
    PubMedGoogle Scholar
  • 11 Driscoll PV, Ramachandrula A, Drezner DA, Hicks TA, Schaffer SR. Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?. Otolaryngol Head Neck Surg 1993; 109 (04) 676-679
    CrossrefPubMedGoogle Scholar
  • 12 Anderhuber W, Walch C, Köle W. A rare case of malignant otitis external in a non-diabetic patient. [in German]. Laryngorhinootologie 1995; 74 (07) 456-459
    PubMedGoogle Scholar
  • 13 Weinroth SE, Schessel D, Tuazon CU. Malignant otitis externa in AIDS patients: case report and review of the literature. Ear Nose Throat J 1994; 73 (10) 772-774 , 777–778
    CrossrefPubMedGoogle Scholar
  • 14 Schweitzer VG. Hyperbaric oxygen management of chronic staphylococcal osteomyelitis of the temporal bone. Am J Otol 1990; 11 (05) 347-353
    PubMedGoogle Scholar
  • 15 Yang TH, Kuo ST, Young YH. Necrotizing external otitis in a patient caused by Klebsiella pneumoniae. Eur Arch Otorhinolaryngol 2006; 263 (04) 344-346
    CrossrefPubMedGoogle Scholar
  • 16 Kountakis SE, Kemper Jr JV, Chang CY, DiMaio DJ, Stiernberg CM. Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 1997; 18 (01) 19-22
    CrossrefPubMedGoogle Scholar
  • 17 Sethi A, Sabherwal A, Gulati A, Sareen D. Primary tuberculous petrositis. Acta Otolaryngol 2005; 125 (11) 1236-1239
    CrossrefPubMedGoogle Scholar
  • 18 Amorosa L, Modugno GC, Pirodda A. Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 1996; 521: 3-16
    CrossrefPubMedGoogle Scholar
  • 19 Gherini SG, Brackmann DE, Bradley WG. Magnetic resonance imaging and computerized tomography in malignant external otitis. Laryngoscope 1986; 96 (05) 542-548
    CrossrefPubMedGoogle Scholar
  • 20 Chang PC, Fischbein NJ, Holliday RA. Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol 2003; 24 (07) 1310-1316
    PubMedGoogle Scholar
  • 21 Benecke Jr JE. Management of osteomyelitis of the skull base. Laryngoscope 1989; 99 (12) 1220-1223
    PubMedGoogle Scholar
  • 22 Kimmelman CP, Lucente FE. Use of ceftazidime for malignant external otitis. Ann Otol Rhinol Laryngol 1989; 98 (09) 721-725
    CrossrefPubMedGoogle Scholar
  • 23 Pedersen HB, Rosborg J. Necrotizing external otitis: aminoglycoside and β-lactam antibiotic treatment combined with surgical treatment. Clin Otolaryngol Allied Sci 1997; 22 (03) 271-274
    CrossrefPubMedGoogle Scholar
  • 24 Lang R, Goshen S, Kitzes-Cohen R, Sadé J. Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients. J Infect Dis 1990; 161 (03) 537-540
    CrossrefPubMedGoogle Scholar
  • 25 Spielmann PM, Yu R, Neeff M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol 2013; 127 (Suppl. 01) S8-S12
    CrossrefPubMedGoogle Scholar
  • 26 Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R. The role of the otorhinolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol 2007; 21 (03) 281-285
    CrossrefPubMedGoogle Scholar
  • 27 Bernstein 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 (02) 118-123
    CrossrefPubMedGoogle Scholar
  • 28 Mader JT, Love JT. MEO cure with HBO as adjuvant therapy. Arch Otorhinolaryngol 1982; 108: 38-40
    PubMedGoogle Scholar