A Rare Complication of Chronic Otitis Media: Central Skull Base Osteomyelitis Managed With Combined Endoscopic Transmastoid and Transsphenoidal Debridement. Issue 3 (16th March 2022)

• Record Type: Journal Article
• Authors: Suresh, Krish; Chari, Divya A.; Bartholomew, Ryan A.; Tward, Aaron D.; Kozin, Elliott D.; Barshak, Miriam B.; Holbrook, Eric H.; Lee, Daniel J.
• Is Part Of: Otology & neurotology. Volume 43:Issue 3(2022)
• Page Start: e344
• Page End: e347
• Publication Date: 2022-03-16
• Subjects: Cholesteatoma -- Chronic otitis media -- Endoscopy -- Osteomyelitis -- Skull base -- Surgical debridement; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000003444
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: This report describes a case of otogenic central skull base osteomyelitis (CSBO) requiring complex surgical intervention and reviews the literature on management of this entity. Patient: A 76-year-old man presented with a nearly 20-year history of chronic otomastoiditis and cholesteatoma with ultimate progression to severe CSBO with involvement of the petrous apex, clivus, and craniocervical junction. Interventions: CSBO was managed with culture-directed antibiotic therapy, hyperbaric oxygen, and surgical intervention including serial combined endoscopic transmastoid and transsphenoidal debridements. Main outcome measures: Symptom resolution, antibiotic holiday, and stable disease on surveillance imaging. Results: With antibiotic treatment and surgical debridement including creation of a drainage pathway from the skull base to the sphenoid sinus, intermittent stretches of disease quiescence were realized over the course of nearly a decade. Despite extensive debridement and skull base reconstruction, the patient ultimately succumbed to the disease process. Conclusions: CSBO poses significant management challenges to the otologist. Herein, we present a rare case of CSBO managed over a prolonged period of time with antibiotics and combined anterior and lateral skull base debridement.