Skull Base Osteomyelitis - Extent, Clinical Impact and Medical Management

Original Research Article Skull base osteomyelitis is a complex and fatal clinical entity that is often misdiagnosed for malignancy. Typical SBO are initiated by ear infection with Pseudomonas Aeruginosa as the usual pathogen, whereas atypical SBO centred on the sphenoid and occipital bones rather than temporal bone. Culture sensitivities will guide the choice of antibiotics, influenced by local prescribing policies. Infective causes must be included in the differential diagnosis of all patients with skull base masses, not just diabetic and immunocompromised patients, especially in the setting of headache, raised ESR and CRP, and multiple lower CNP. Accurate diagnosis and evaluation of the disease depends on appropriate physical examination and radiological assessment including both CT and MRI scans. Treatment with quinolones – especially Ciprofloxacin is the first line treatment for skull base osteomyelitis. If the diagnosis is made and aggressive treatment started early as per culture and sensitivity or empirical based treatment, for appropriate period of time, outcome has improved without any surgical intervention, neural deficit improves, although full recovery of cranial nerve function may not occur.