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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)

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