Osteomyelitis Of Temporal Bone Research Articles

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review.

Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis. A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes. Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy. Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.

Chronic otitis media progressing to temporal bone osteomyelitis and sequestration with mastoid cavity myiasis in paediatric age group: an unusual case report

<p>Myiasis is the infestation by fly larvae. There are few sporadic publications regarding human ear myiasis. Osteomyelitis of temporal bone is also an uncommon entity. This study aims to describe the clinical presentation and management of a unique presentation of mastoid cavity myiasis and sequestration in a 4 year old child, who presented to Chigateri district hospital, Davangere with blood tinged discharge along with visible maggots from left external auditory canal and post auricular sinus since 3 days, with history of chronic otitis media. After manual cleaning of maggots, high resonance computed tomography of temporal bone was done, which showed findings suggestive of foreign body with bony density. Modified radical mastoidectomy was done, where osteomyelitis of temporal bone with sequestrum was encountered on table and removed. Diagnosis of temporal bone osteomyelitis requires a high degree of suspicion, especially in a setting of myiasis, as these 2 rare pathologies have not been reported to co-occur in literature. Early intervention is essential to avoid fatal complications of this infrequent presentation.</p>

A Comprehensive Review of Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges among Various Presentations.

Skull base osteomyelitis (SBO) is a complex and fatal clinical entity that is often misdiagnosed for malignancy. SBO is commonly a direct complication of otogenic, sinogenic, odontogenic, and rhinogenic infections and can present as central, atypical, or pediatric clival SBO. This review describes the clinical profile, investigational approach, and management techniques for these variants. A comprehensive literature review was performed in PubMed, MEDLINE, Research Gate, EMBASE, Wiley Online Library, and various Neurosurgical and Neurology journals with the keywords including: SBO, central or atypical SBO, fungal osteomyelitis, malignant otitis externa, temporal bone osteomyelitis, and clival osteomyelitis. Each manuscript's reference list was reviewed for potentially relevant articles. The search yielded a total of 153 articles. It was found that with early and aggressive culture guided long-term intravenous broad-spectrum antibiotic therapy decreases post-infection complications. In cases of widespread soft tissue involvement, an early aggressive surgical removal of infectious sequestra with preferentially Hyperbaric Oxygen (HBO) therapy is associated with better prognosis of disease, less neurologic sequelae and mortality rate. Complete resolution of the SBO cases may take several months. Since early treatment can improve mortality rates, it is paramount that the reporting radiologists and treating clinicians are aware of the cardinal diagnostic signs to improve clinical outcomes of the disease. It will decrease delayed diagnosis and under treatment of the condition. However, due to rarity of the condition, complete prognostic factors have not fully been analyzed and discussed in the literature.

Paradoxical Vestibular Syndrome Secondary to Temporal Bone Osteomyelitis and Chronic Otitis Interna in a Guinea Pig (Cavia porcellus)

A 3-year-old female intact guinea pig (Cavia porcellus) was presented for torticollis and ocular discharge. On examination, the guinea pig had a left head tilt with corneal ulceration and absent palpebral response of the right eye. Computed tomography showed a soft tissue attenuating mass with multifocal mineralization compressing the caudal cerebellum with moderate lysis of the calvarium. On recheck, the disease had progressed to include ataxia and proprioceptive deficits. Systemic antibiotic therapy was initiated but the guinea pig only exhibited a marginal treatment response. Due to poor quality of life, the guinea pig was euthanized. A necropsy was performed and a bony lesion was found within the skull compressing the right cerebellum and temporal lobe. Histopathology revealed suppurative osteomyelitis consistent with severe chronic bacterial otitis interna. Vestibular signs in small exotic companion mammals are a common sequela to otitis interna, often noted ipsilateral to an affected inner ear, however, in this case rare paradoxical vestibular signs were observed. Severe chronic otitis interna may result in bony lysis and proliferation capable of expanding from the inner ear resulting in neurological deficits.

Osteomyelitis of temporal bone: A case report of a rare disease

Osteomyelitis of temporal bone affecting the squamous portion is a very rare entity. We present here a case of osteomyelitis affecting the squamous portion of temporal bone following blunt trauma to the head.

Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies.

Cranial osteomyelitis is a rare but potentially life-threatening condition that requires early diagnosis with prompt and appropriate management by neurosurgeons to prevent further central nervous system complications. The literature in the Medline database was comprehensively reviewed with the keywords "cranial osteomyelitis," "skull base osteomyelitis (SBO)," "central skull base osteomyelitis," and "temporal bone osteomyelitis." Items in the reference list of each article relevant to the objective of this study were reviewed. This review produced 183 articles: 13 book chapters, 24 case reports, 17 case series, 98 original articles, 30 review articles, and 1 meta-analysis. We classified cranial osteomyelitis as sinorhino-otogenic, including anterior, middle, and posterior skull base osteomyelitis; and non-sinorhino-otogenic, including iatrogenic, posttraumatic, hematologic, and osteomyelitis with other causes. New diagnostic modalities, the introduction of broad-spectrum antibiotics, and recent advances in neurosurgical procedures have led to a decrease in the rate of treatment failure in cranial osteomyelitis. Early recognition of initial nonspecific symptoms is key to diagnosing and managing this treatable but life-threatening condition. Early identification of the causative pathogen, appropriate broad-spectrum antibiotic therapy over a period of 8-20 weeks, and aggressive surgical debridement are essential for managing cranial osteomyelitis. On the other hand, inadequate treatment is responsible for refractory cases and poses a great diagnostic challenge. A new classification dividing cranial osteomyelitis into sinorhino-otogenic versus nonsinorhino-otogenic groups could prove valuable for clinical communication and treatment.

手術により制御できた若年者の側頭骨骨髄炎例

手術により制御できた若年者の側頭骨骨髄炎例

A Case of a Young Patient with Temporal Bone Osteomyelitis Cured by Surgery

A Case of a Young Patient with Temporal Bone Osteomyelitis Cured by Surgery

Osteomyelitis of the temporal bone: terminology, diagnosis, and management.

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.

Pipeline embolization device and subsequent vessel sacrifice for treatment of a bleeding carotid pseudoaneurysm at the skull base: a case report

An attempt at parent vessel reconstruction with Pipeline embolization devices to treat a mycotic pseudoaneurysm of the internal carotid artery at the skull base is presented. A 50-year-old woman with...

Bilateral Skull Base Osteomyelitis in an Immunocompetent Patient

A 75-year-old immunocompetent man presented to our office with right otalgia. After a comprehensive workup, he was found to have right temporal bone osteomyelitis and was treated with intravenous antibiotics. He then began to experience left-sided otalgia and was diagnosed with and treated for left temporal bone osteomyelitis. Subsequently, he began to exhibit myelopathic symptoms, and imaging revealed a C2 inflammatory process. The patient underwent endoscopic transoral odontoidectomy with resection of a large C1 to C2 pannus and recovered with no neurologic deficit. Skull base osteomyelitis is an uncommon condition that usually occurs in immunocompromised patients. Prompt diagnosis and appropriate treatment are of utmost importance in managing this condition.

離乳豚の接合菌による側頭骨骨髄炎

離乳豚の接合菌による側頭骨骨髄炎

Usefulness of hybrid SPECT/CT for the 99mTc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis

Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.

Petrositis with inferior cranial nerves involvement: A case report

Introduction: Petrositis, osteomyelitis of temporal bone, is a rare complication of middle ear infection or mastoiditis. Symptoms reported in patients with petrositis are otalgia, deep facial pain, headache, otorrhea, fever, coma and cranial nerve paralysis. Current diagnostic tests for this complication include high-resolution CT scan, brain MRI and bone scan with Technetium, Gallium and Indium 1-11. Case report: A 34 years old lady with left multiple cranial nerves palsies of VII, VIII, IX, X, XII is presented. She had a history of otitis media and then mastoiditis in left side 6 months ago which was underwent tympanomastoidectomy. In radiological studies there was involvement of parameninge tissue next to petrous bone. Gallium scan was highly suggestive for petrous osteomyelitis. She was treated with empiric parenteral antibiotics and her symptoms resolved completely.

Osteomyelitis of Temporal Bone Associated with Tonsillar Focal Infection

We report here on two cases wherein it is conceivable that the osteomyelitis of the temporal bone was brought on by secondary complications associated with tonsillar focal infection. The main change to the bone was non-specific osteomyelitis. Cryptitis of the tonsils or fibrosis surrounding the blood vessels (onion skin lesion) was characteristic findings in the pathological studies.

Bone scintigraphy in the diagnosis of fracture and infection of the temporal bone.

The sensitivity of 99mTc-MDP-bone-scintigraphy in the diagnosis of temporal bone fracture was found equal to that of conventional radiography if the patients were examined 10 days after the trauma. Temporal bone osteomyelitis with concomitant moderate osteosclerosis was demonstrated by bone scintigraphy in 5 cases of mastoiditis with atypical symptoms. A case of apicitis was for the first time demonstrated by scintigraphy. A low sensitivity of 67Ga-scintigraphy was demonstrated by positive 99mTc-bone-scintigraphy and negative 67Ga-scintigraphy in a patient with atypical mastoiditis. 99mTc-scintigraphy was negative in 5 cases of otitis media suppurativa and in 3 cases of otitis media chronica cum cholesteatoma, all with slight degree of osteosclerosis in the mastoid. The sensitivity of 99mTc-bone-scintigraphy in fracture and osteomyelitis of the temporal bone seems to be a function of the amount of reactive new bone formed.

Histopathology of pseudomonas osteomyelitis of the temporal bone starting as malignant external otitis

Although the natural history and treatment of "malignant external otitis" have been well described, available histopathologic data are limited to three case reports. The histopathology in two additional cases, in which the disease process was advanced and uncontrolled, is presented to illustrate the unique progression of temporal bone osteomyelitis due to the Pseudomonas organism. In both cases the bony labyrinthine capsule demonstrated remarkable resistance to the osteomyelitic process even though the infection seemed to pass around the inner ear from all sides. The most active area of osteomyelitis was at the skull base along the sigmoid sulcus, posterior fossa surface of the temporal bone, and petrous apex. Spread to the opposite petrous apex occurred anterior to the foramen magnum via the basisphenoid, cavernous sinus, and peritubal areas. The clinical and histopathologic data demonstrated that the disease process had a similar progression in both cases, starting in the external auditory canal with spread to the stylomastoid and jugular foramina. This resulted in septic thrombosis of the lateral venous sinus and subsequent extension to the petrous apex from both posterior and middle fossa surfaces of the petrous bone. The infection spread along vascular and fascial planes rather than through pneumatized tracts of the temporal bone. The treatment of this disease is discussed in the light of the histopathologic findings.

Tubercular osteomyelitis of the mastoid temporal bone

Infective osteomyelitis of mastoid temporal bone was a frequent complication of middle ear disease before the advent of antibiotics and chemotherapy, but now it is quite rare (Kelemen, 1957, Misra & Prakash, 1968). Tubercular osteomyelitis is rarer still (Shambaugh, 1959). A case of tubercular osteomyelitis of the mastoid temporal bone is reported.

CLINICAL AND HISTOPATHOLOGICAL STUDIES OF CHRONIC SUPPURATION OF THE TEMPORAL BONE ACCOMPANIED WITH SEVERE HEARING LOSS

The author reports clinical and histopathological studies in seven cases with chronic suppuration of the temporal bone accompanied with severe hearing loss. The specimens examined were taken from each part the temporal bone at the radical or conservative radical operation (S. Niho) for osteomyelitis of temporal bone.(1) In recent years, since the advent of chemo-antibiotic therapy, the findings of the ear drum of patients with chronic suppuration of the temporal bone are less significant compared with histopathological findings of the specimens taken from the temporal bone. Of most importance are X-ray findings of the temporal bone especially in infants.'(2) Among the many reported methods of X-ray study of the temporal bone, Stenver's position is the best, and films taken in this position revealed more or less manifest pathological changes in all of these seven cases.(3) In prevention of chronic mastoiditis and petrositis it is necessary to eliminate disorders in the nose and throat, performing tonsillectomy and adenoidectomy even if the patients are only one or two years of age. It is also necessary to perform attico-mastoidectomy or conservative radical operation for osteomyelitis of temporal bone, even in infants.(4) In such severe cases in young children, chronic pneumato-cellulitis, osteitis and osteomy-Pelitis are observed histopathologically. However, in. long standing cases especially these in whom more than twenty years .had elapsed, chronic pneumato-cellulitis is very rare and chronic osteitis and osteomyelitis are demonstrated.In the soft tissue, thickening of the epithelium, edematous swelling of subepithelial -and periosteal layers, infiltration of polymorphnuclear leucocytes, histiocytes, plasma cells, round cells and sometimes eosinophile leucocytes, granulation tissue and its organization, etc. are observed.As histopathological changes of the bony tsisue removed at the operation of the temporal.bone, the following, findings are revealed: marked degeneration, for example, pycnosis or. disappearance of the bone nuclei, indistinction or disappearance of bone lamellae, appearance of abnormal lamellae, chemical absorption of the bone (halisteresis), bone necrosis, absorption by osteoclasts (lacunar absorption), absorption by granulation tissue, widening of bone cavity, another type of porosis, widening of Haver's canaliculi and other bone canaliculi, increase of bone canalleuli in.a broad sense and of. the marrow tissue, osteoporosis, circulatory disturbance of fluid, .edema and fibrosis in the bone canaliculi in a broad sense or in, the marrow tissue, appearance of, osteoblasts, bone proliferation and appearance of osteoid-tissue, etc.Summarizing the above mentioned findings, bony damages. may disturb the healing of soft tissue, and circulatory disturbances of fluid in soft tissue may disturb the healing of the bone tissue.(5) As a result of existence of these pathological changes around the labyrinth for a long time, development of osteoporosis of the bony capsule of the semicircular canals with eventual labyrinthitis has been demonstrated. In the author's opinion similar pathological processes may occur sometimes in the cochlear capsule and in such incidences circulatory disturbances of fluid or inflammatory changes may have some influence on the cochlear function, which may become gradually less active and conductive deafness may become mixed deafness.Accordingly, for restoration of the cochlear function, it is of importance to eliminate such damaged bone tissue around the cochlea by performing the radical operation for osteomyelitis of temporal bone recommended by S. Niho.

Acute Osteomyelitis of Right Temporal Bone in a Boy; Operations; Recovery.

Acute Osteomyelitis of Right Temporal Bone in a Boy; Operations; Recovery.