Introduction:
Skull base osteomyelitis (SBO) is an invasive infection in which
pathogens spread to the periosteum of the temporal bone and tissue
planes, causing necrosis. Chandler coined the term malignant otitis
externa (MOE) in 1968.1 Synonyms like necrotizing
otitis externa, temporal bone osteomyelitis, and SBO also are used. SBO
accurately describes the pathophysiology of the
disease.2 In atypical or central SBO, sphenoid and
occipital bones are affected.3 The disease commonly
affects people with diabetes with poor chemotaxis, phagocytosis, and
humoral immunity.4 Diagnosis is from clinical
features, culture, histopathology, and imaging modalities like CT and
MRI scans. PET CT and PET MRI having a superior spatial resolution, less
radioactivity, and higher sensitivity and specificity, have been
preferred lately over other nuclear scans to diagnose and determine the
resolution of SBO. 5- 8
When initially described by Chandler, the treatment was mainly surgical,
along with antibiotics like Colistin or Polymixin, with a mortality of
46%.1 With broad-spectrum antibiotics, surgical
interventions have become a rarity, and mortality has reduced to 10%.
With the emergence of refractory cases probably due to
multidrug-resistant strains, fungal pathogen, and lack of positive
culture, the role of surgery is being considered by many centres to
shorten the hospital stay and duration of treatment.9While antimicrobials and polypharmacy pose problems in treating these
elderly immunocompromised patients, surgery may increase morbidity
further. The role of surgery in the treatment of refractory SBO forms
the study’s objective.