Skull base osteomyelitis: factors implicating clinical outcome

Acta Neurol Belg. 2019 Sep;119(3):431-437. doi: 10.1007/s13760-019-01110-w. Epub 2019 Mar 6.


Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient's medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

Keywords: Cranial nerve; Osteomyelitis; Otitis media; Skull base.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cranial Nerve Diseases / etiology
  • Cranial Nerve Diseases / therapy
  • Female
  • Humans
  • Length of Stay*
  • Male
  • Middle Aged
  • Osteomyelitis / diagnosis*
  • Osteomyelitis / etiology
  • Osteomyelitis / therapy*
  • Otitis Externa / complications
  • Outcome Assessment, Health Care*
  • Paresis / etiology
  • Paresis / therapy
  • Prognosis
  • Retrospective Studies
  • Skull Base* / immunology
  • Skull Base* / pathology