Osteomyelitis of the Temporal Bone: Terminology, Diagnosis, and Management

• Published in: Journal of neurological surgery. Part B, Skull base Vol. 75; no. 5; pp. 324 - 331
• Main Authors: Prasad, Sampath Chandra, Prasad, Kishore Chandra, Kumar, Abhijit, Thada, Nikhil Dinaker, Rao, Pallavi, Chalasani, Satyanarayana
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.10.2014
• Subjects: Original Article; osteomyelitis; diabetes mellitus; temporal bone; malignant external otitis; skull base osteomyelitis
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0034-1372468

Abstract Objectives  To review the terminology, clinical features, and management of temporal bone osteomyelitis. Design and Setting  Prospective study in a tertiary care center from 2001 to 2008. Participants  Twenty patients visiting the outpatient department diagnosed with osteomyelitis of the temporal bone. Main Outcome Measures  The age, sex, clinical features, cultured organisms, surgical interventions, and classification were analyzed. Results  Of the 20 cases, 2 (10%) were diagnosed as acute otitis media. Eighteen (90%) had chronic otitis media. Nineteen (95%) were classified as medial temporal bone osteomyelitis and one (5%) as lateral temporal osteomyelitis. The most common clinical features were ear discharge (100%), pain (83%), and granulations (100%). Facial nerve palsy was seen in seven cases (35%) and parotid involvement in one case. Ten patients (56%) had diabetes mellitus. The organisms isolated were Pseudomonas aeruginosa (80%) and Staphylococcus aureus (13.33%). Histopathology revealed chronic inflammation in 20 patients (100%) and osteomyelitic bony changes in 14 (70%). Surgical debridement was the most preferred modality of treatment (87%). Conclusion  A new classification of temporal bone osteomyelitis has been proposed. Bacterial cultures must be performed in all patients. Antibiotic therapy is the treatment of choice. Surgical intervention is necessary in the presence of severe pain, complications, refractory cases, or the presence of bony sequestra on radiology.