scholarly journals A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Brijesh Patel ◽  
Anas Souqiyyeh ◽  
Ammar Ali
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Otitis Externa ◽  
Skull Bone ◽  
Topical Antibiotics ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
The Common

Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

scholarly journals Atypical skull base osteomyelitis in the intensive care unit: A case report

2017 ◽  
Vol 5 (1) ◽  
pp. 15
Author(s):  
Pradeep Hiremath ◽  
Pradeep Rangappa ◽  
Ipe Jacob ◽  
Sriram Patwari ◽  
Karthik Rao
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Microbiological Analysis ◽  
Biopsy Material ◽  
Jugular Veins ◽  
Skull Base Osteomyelitis ◽  
Base Of Skull ◽  
Cranial Nerve Palsies ◽  
Magnetic Resonance Imaging Mri

Base of skull osteomyelitis is commonly seen as a complication of malignant otitis externa, involving the temporal bone. It initially presents with aural symptoms such as ear ache and discharge and cranial nerve palsies. We report an atypical presentation of skull base osteomyelitis that did not show signs of otitis externa. The patient presented with severe headache, drowsiness and signs of bulbar weakness including pooling of oropharyngeal secretions. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) studies showed a bony erosion of the left side of base of skull involving the sphenoid bone and surrounding foramina, left sided coalescent mastoiditis and inflammation of the left parapharyngeal space. There was also inflammation of the tissues encasing the internal carotid artery and jugular veins and thrombosis of left jugular vein. These imaging findings along with cranial nerve palsies were suggestive of malignancy. However, tissue biopsy was negative for malignancy. The growth of Pseudomonas aeruginosa in the biopsy material as well as nasopharyngeal and blood cultures along with elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels led to a diagnosis of base of skull osteomyelitis. Hence diagnosis in such cases requires that biopsy material be sent for microbiological analysis, in addition to histology.

Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges in Atypical Presentation

2005 ◽  
Vol 133 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Amar Singh ◽  
Mazin Al Khabori
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Cranial Nerves ◽  
Contralateral Side ◽  
Lateral Sinus ◽  
Skull Base Osteomyelitis ◽  
Atypical Symptoms ◽  
Malignant Otitis Externa ◽  
Atypical Manifestations

OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbitity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

scholarly journals A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Haruka Miyabe ◽  
Atsuhiko Uno ◽  
Takahiro Nakajima ◽  
Natsue Morizane ◽  
Keisuke Enomoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cranial Nerve ◽  
Initial Presentation ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Life Threatening ◽  
The Right

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence ofPseudomonas aeruginosain the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

scholarly journals Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

2020 ◽  
Vol 50 (1) ◽  
pp. 77
Author(s):  
Ratna Dwi Restuti
Keyword(s):  
Diabetes Mellitus ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Geriatric Patients ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

scholarly journals Advanced Imaging Techniques in Skull Base Osteomyelitis Due to Malignant Otitis Externa

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
A. M. J. L. van Kroonenburgh ◽  
W. L. van der Meer ◽  
R. J. P. Bothof ◽  
M. van Tilburg ◽  
J. van Tongeren ◽  
...  
Keyword(s):  
Skull Base ◽  
Otitis Externa ◽  
Imaging Techniques ◽  
Advanced Imaging ◽  
Skull Base Osteomyelitis ◽  
Malignant Otitis Externa

scholarly journals A Case Series of Malignant Otitis Externa Mimicking Malignancy

2021 ◽  
Vol 64 (1) ◽  
pp. 36-41
Author(s):  
Vengathajalam Selvamalar ◽  
Nik Adilah Nik Othman ◽  
Mohd Khairi Daud
Keyword(s):  
Cranial Nerve ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Series ◽  
Lower Cranial Nerve ◽  
Cortical Mastoidectomy ◽  
Cranial Nerve Palsies ◽  
Adjacent Structures ◽  
Malignant Otitis Externa

Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.

scholarly journals Malignant otitis externa with skull base osteomyelitis

2011 ◽  
Vol 2011 (5) ◽  
pp. 6-6 ◽  
Author(s):  
E Illing ◽  
M Zolotar ◽  
E Ross ◽  
O Olaleye ◽  
N Molony
Keyword(s):  
Skull Base ◽  
Otitis Externa ◽  
Skull Base Osteomyelitis ◽  
Malignant Otitis Externa

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

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