Optimal Diagnostic Criteria and a Staging System for Otogenic Skull Base Osteomyelitis

Abstract

Objective Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria and a staging system for otogenic SBO that is associated with infection control and mortality.

Design The present study is designed as a retrospective one.

Setting This study was conducted at the University Hospital.

Participants Thirteen patients with otogenic SBO who met the novel rigorous diagnostic criteria consisted of symptomatic and radiological signs on high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI). Simple refractory external otitis was not included. A staging system according to disease extent revealed by HRCT and MRI is proposed: lesions limited to the temporal bone (stage 1), extending to less than half (stage 2), exceeding the midline (stage 3), and extending to the whole of the clivus (stage 4). All patients received long-term antibiotic therapy. Patients were divided into infection-uncontrolled or -controlled groups based on symptoms, otoscopic findings, and C-reactive protein level at the last follow-up. The mean follow-up period was 27.7 months.

Main Outcome Measures Possible prognostic factors, such as immunocompromised status and symptoms, including cranial nerve palsy, pretreatment laboratory data, and treatments, were compared between the infection-uncontrolled and -controlled groups. Disease stages were correlated with infection control and mortality.

Results The infection-uncontrolled rate and mortality rate were 38.5 and 23.1%, respectively. There were no significant differences in possible prognostic factors between the infection-uncontrolled and -controlled groups. HRCT-based stages significantly correlated with infection control and mortality.

Conclusion We proposed here the clinically useful diagnostic criteria and staging systems that can predict infection control and prognosis of otogenic SBO.

Keywords

skull base osteomyelitis - malignant external otitis - diagnostic criteria - infection control - mortality - HRCT - MRI - staging

Note

This work was approved by the Institutional Review Board of the Niigata University Medical and Dental Hospital (approval no.: 2019–0306).

Publikationsverlauf

Eingereicht: 16. März 2021

Angenommen: 08. Juni 2021

Artikel online veröffentlicht:
16. Juli 2021

• References

• 1 Meltzer P, Kelemen G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959; 69: 1300-1316
• 2 Chandler JR. Malignant external otitis. Laryngoscope 1968; 78 (08) 1257-1294
• 3 Chandler JR, Grobman L, Quencer R, Serafini A. Osteomyelitis of the base of the skull. Laryngoscope 1986; 96 (03) 245-251
• 4 Chandler JR. Pathogenesis and treatment of facial paralysis due to malignant external otitis. Ann Otol Rhinol Laryngol 1972; 81 (05) 648-658
• 5 Franco-Vidal V, Blanchet H, Bebear C, Dutronc H, Darrouzet V. Necrotizing external otitis: a report of 46 cases. Otol Neurotol 2007; 28 (06) 771-773
• 6 Chen C-N, Chen Y-S, Yeh TH, Hsu CJ, Tseng FY. Outcomes of malignant external otitis: survival vs mortality. Acta Otolaryngol 2010; 130 (01) 89-94
• 7 Soudry E, Hamzany Y, Preis M, Joshua B, Hadar T, Nageris BI. Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 2011; 144 (05) 758-762
• 8 Stern Shavit S, Soudry E, Hamzany Y, Nageris B. Malignant external otitis: Factors predicting patient outcomes. Am J Otolaryngol 2016; 37 (05) 425-430
• 9 Glikson E, Sagiv D, Wolf M, Shapira Y. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series. Diagn Microbiol Infect Dis 2017; 87 (01) 74-78
• 10 Lee SK, Lee SA, Seon SW. et al. Analysis of prognostic factors in malignant external otitis. Clin Exp Otorhinolaryngol 2017; 10 (03) 228-235
• 11 Eveleigh MO, Hall CE, Baldwin DL. Prognostic scoring in necrotising otitis externa. J Laryngol Otol 2009; 123 (10) 1097-1102
• 12 Peled C, El-Seid S, Bahat-Dinur A, Tzvi-Ran LR, Kraus M, Kaplan D. Necrotizing otitis externa-analysis of 83 cases: clinical findings and course of disease. Otol Neurotol 2019; 40 (01) 56-62
• 13 Strauss M, Aber RC, Conner GH, Baum S. Malignant external otitis: long-term (months) antimicrobial therapy. Laryngoscope 1982; 92 (04) 397-406
• 14 Lesser FD, Derbyshire SG, Lewis-Jones H. Can computed tomography and magnetic resonance imaging differentiate between malignant pathology and osteomyelitis in the central skull base?. J Laryngol Otol 2015; 129 (09) 852-859
• 15 Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364 (9431): 369-379
• 16 Spielmann PM, Yu R, Neeff M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol 2013; 127 (Suppl. 01) S8-S12
• 17 Ridder GJ, Breunig C, Kaminsky J, Pfeiffer J. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol 2015; 272 (05) 1269-1276
• 18 Sokołowski J, Lachowska M, Karchier E, Bartoszewicz R, Niemczyk K. Skull base osteomyelitis: factors implicating clinical outcome. Acta Neurol Belg 2019; 119 (03) 431-437
• 19 Jacobsen LM, Antonelli PJ. Errors in the diagnosis and management of necrotizing otitis externa. Otolaryngol Head Neck Surg 2010; 143 (04) 506-509
• 20 Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouraei R. Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol 2008; 29 (05) 666-672
• 21 Johnson AK, Batra PS. Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope 2014; 124 (05) 1083-1087
• 22 Clark MPA, Pretorius PM, Byren I, Milford CA. Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 2009; 19 (04) 247-254