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Necrotizing Base of Skull Ostiomylitis
Transcript of Necrotizing Base of Skull Ostiomylitis
Is an aggressive and potentially fatal infection originating commonly in the external auditary canal in Diabatic pts, with progressive spread along the soft tissues and bone of the skull base via santorini’s fissures, ultimately involving intracranial structures
Malignant otitis externa (in 1959, meltzer & Kelemen presented the first case )
In 1974, chandler report 13 cases (from 1968 to 1974)
Necrotizing external otits
Osteomylitis of the base of the skull
65-70 years old
Male: female, 1.8:1
Immunocompromised patients (DM, HIV, On immunosuppression) WHY???
P.aeruginosa >90% >>
gram -ve aerobe not normally found in the EAC.
contain a mucoid surface layer that protect it from phagocytosis
produce lytic enzymes causing necrotizing vasculitis
will colonize in a moist environment and in the absence of effictive host defenes
Aural water exposure
Granulation tissue in the inferior portion of the external auditory canal at the bone-cartilage junction ( santorini’s fissures )
Culture of ear secretion and Tissue biopsy
Technetium 99m scan (diagnostic)
Gallium citrate Ga 67 scintigraphy (follow up)
Ciprofloxacin 750 mg PO BID
+ Rifampcin 600mg BID
for 6 to 12 weeks
Treatment of Resistant P. aeruginosa
hospitalization for biopsy, debridement and parenteral antibiotics >> Amphotericin B (>12 week)
Study on February 2006
6-week course of:
topical aminoglycoside steroid drops
Treatment of Culture-Negative Skull Base Osteomyelitis
Dural sinus thrombophlebitis
Done By: Hanan Saleh Abu AL-faraj
Supervised By: Dr.Adel Lotfy
Otalgia >90% (throbbing pain, nocturnal)
Purulent otorrhea >90%
Trismus (temporomandibular joint)
facial nerve palsy 20% >>> why
Obligatory criteria (major):
pain, edema, exudate, granulations,
positive Technetium 99 scan or
failure of local treatment often more
than 1 week,pseudomonas in culture.
Occasional criteria (minor):
diabetes, cranial nerve involvement,
positive radiograph, old age.
Two-drug combination therapy
antipseudomonal with an aminoglycoside for 4-8 weeks, depending on the extent of involvement.
Gentamicin ,Tobramycin , Amikacin
penicillin : Ticarcillin ,Timentin,Piperacillin ,....
quinolones : Ciprofloxacin , levofloxacin,.....
3rd/ 4th generation cephalosporins : Ceftazidime , cefepime, ..
– purulent otorrhoea, otalgia (out of proportion), granulation tissue on otoscopy.
– disease extends to soft tissues and skull base with or without involvement of CN .
– intracranial extension.
Otitis media not responing to usual ttt
In 1989 >>>
Thanks for inspiring me...
Control the DM
Aspergillus ,staphylococcus aureus,
proteus mirabilis, klebsiella oxytoca,