Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification

Otol Neurotol. 2008 Aug;29(5):666-72. doi: 10.1097/MAO.0b013e318179972f.


Objectives: To review the presentation, microbiology, and long-term results of treating otogenic cranial base osteomyelitis to develop a prognosis-based disease classification system.

Patients and methods: Thirty-eight patients with otogenic cranial base osteomyelitis treated between 1989 and 2002 were studied. Patient demographics, presentation, pathogens, details of therapy, and disease-specific survival were recorded. Patients were stratified using Technetium-99 single-photon emission computerized tomography (SPECT) at presentation into 4 grades: I, mild uptake; II, focal mastoid/temporal bone uptake not reaching midline; III, petrous temporal bone uptake reaching midline; and IV, uptake crossing midline, involving the contralateral temporal bone. Actuarial analysis was used to identify prognostic factors.

Results: There were 27 men. The average age at presentation was 65 +/- 16 years (range, 19-95 yr). The median age-adjusted Charlson comorbidity score was 5, and 63% of patients were diabetic. The most common presenting symptoms were pain and otorrhea, and 8 patients had cranial nerve neuropathy. Pseudomonas aeruginosa was the most common bacterial pathogen (n = 28; 74%), and 9 patients had fungal or mixed infections. On average, antibiotics were administered for 161 days, and 6 patients had concomitant surgery. The average follow-up was 33 months, and 3-year disease-specific survival was 76%. Univariate predictors of survival were the SPECT grade, fungal/mixed infections, Charlson score, immune compromise, and cranial nerve neuropathy. The only independent predictor of survival on multivariate Cox regression was the SPECT stage at presentation.

Conclusion: Cranial base osteomyelitis is associated with significant morbidity and mortality and requires prolonged treatment. Long-term outcome can be predicted from the initial SPECT scan.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Osteomyelitis / classification*
  • Osteomyelitis / diagnosis
  • Osteomyelitis / microbiology*
  • Otitis Externa / complications*
  • Otitis Externa / microbiology
  • Otitis Media with Effusion / complications*
  • Otitis Media with Effusion / microbiology
  • Prognosis
  • Pseudomonas Infections / complications*
  • Pseudomonas aeruginosa / isolation & purification*
  • Skull Base / diagnostic imaging
  • Skull Base / pathology
  • Tomography, Emission-Computed, Single-Photon