ABSTRACT
Objective: We report cases of central or atypical skull base osteomyelitis and review
issues related to the diagnosis and treatment. Methods: The four cases presented,
which were drawn from the Oxford, United Kingdom, skull base pathology database, had
a diagnosis of central skull base osteomyelitis. Results: Four cases are presented
in which central skull base osteomyelitis was diagnosed. Contrary to malignant otitis
externa, our cases were not preceded by immediate external infections and had normal
external ear examinations. They presented with headache and a variety of cranial neuropathies.
Imaging demonstrated bone destruction, and subsequent microbiological analysis diagnosed
infection and prompted prolonged antibiotic treatment. Conclusion: We concluded that
in the diabetic or immunocompromised patient, a scenario of headache, cranial neuropathy,
and bony destruction on imaging should raise the possibility of skull base osteomyelitis,
even in the absence of an obvious infective source. The primary goal should still
be to exclude an underlying malignant cause.
KEYWORDS
Skull base - osteomyelitis - cranial neuropathies - otitis externa
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Matthew P.A ClarkF.R.C.S.
(ORL-HNS) Specialist Registrar, ENT Department, The West Wing John Radcliffe Hospital
Headley Way
Oxford, OX3 9DU 01865 741 166
eMail: mattanna99@hotmail.com