Abstract
Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.
Highlights
Osteomyelitis of the temporal bone is a rare but lifethreatening complication that is mostly secondary to malignant otitis externa (MOE) and was first recognized as a distinct clinical entity by Meltzer and Kelemen in 1959 [1]
This was a retrospective review of the charts of 55 hospitalized patients with diagnosis of osteomyelitis of the temporal bone who were treated in the Department of Otolaryngology, Taipei Veterans General Hospital, from January 1990 to December 2011
The criteria on which the diagnosis of osteomyelitis of the temporal bone was based included (1) clinical symptoms of persistent otalgia or otorrhea; (2) failure to respond to medical therapy and local treatment; (3) uptake at the temporal bone on bone scan and gallium scan; (4) exclusion of ear tumor by histopathology if granulation tissue was present; and (5) positive findings on computed tomography (CT) or magnetic resonance imaging (MRI)
Summary
Osteomyelitis of the temporal bone is a rare but lifethreatening complication that is mostly secondary to malignant otitis externa (MOE) and was first recognized as a distinct clinical entity by Meltzer and Kelemen in 1959 [1]. There is increased pH in diabetic cerumen, and diabetics have innate defects in chemotaxis and phagocytosis of polymorphonuclear lymphocytes, monocytes, and macrophages, which may contribute to the development of MOE [3, 4]. Since both aging and diabetes mellitus are associated with abnormalities of small blood vessels, it has been postulated that microangiopathy in the ear canal predisposes elderly diabetic patients to MOE [5].
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