Otogenic Skull Base Osteomyelitis: Clinical Presentation, Diagnostic and Therapeutic Challenges, and Long-Term Outcomes from a Single Tertiary Centre

Abstract

Objective: This study assesses the demographic and clinical characteristics, diagnostic and treatment methods, and long-term outcomes of patients diagnosed with and treated for otogenic skull base osteomyelitis (OSBO). Second, we attempted to determine the effect of hyperbaric oxygen treatment (HBOT) on the treatment of OSBO. Material and Methods: We conducted a retrospective analysis of the medical records of 17 patients hospitalised with an OSBO diagnosis in our clinic from 2017 to 2024. We reviewed the demographic infor mation, symptoms, laboratory results, imaging and treatment methods, length of hospital stay, associated complications, and follow-up periods. Results: Nearly all patients, except one, were elderly males (mean age: 68.9 years; range: 57–81 years). All patients had type 2 DM, with 88.2% (n=15) having multiple comorbidities, including hypertension and coronary artery disease. The most common symptoms were otalgia, hearing loss, and otorrhea, with cranial nerve (CN) palsy observed in 70.6% (n=12). Five patients experienced single CN involvement (CN VII in three, CN XII in one, and CN VI in one), while seven had multiple CN palsy. The mean length of hospital stay was 45 days (range: 21–80 days). In addition to intravenous antibiotic therapy, hyperbaric oxygen therapy (HBOT) was administered to 52.9% (n=9). In the HBOT group, no significant reduction was observed in morbidity or length of hospital stay. During the 7-year follow-up period, mortality occurred in 17.6% (n=3). Conclusion: OSBO should be considered as a differential diagnosis in elderly diabetic patients with persistent otalgia and otorrhea who do not respond to empirical antibiotic therapy. Although our study did not reveal any significant effects of HBOT on OSBO prognosis or length of hospital stay, randomised controlled trials are needed to assess its potential benefits.

Keywords

• Skull base osteomyelitis
• temporal bone osteomyelitis
• malignant otitis externa
• hyperbaric oxygen therapy
• cranial nerve palsy
• diabetes mellitus

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