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skull base osteomyelitis: A Rare Cause of Multiple Cranial Nerve Palsies—A Case Report from Ghana

World Journal of Neuroscience 2023年第4期13卷 257-265页

作者： Ekins Kuuzie Prince Kwabla Pekyi-Boateng Annie Yennah Fiifi Duodu Department of Surgery St. Dominic Hospital Akwatia Ghana Department of Anesthesiology 37 Military Hospital Accra Ghana Department of Surgery Ho Teaching Hospital Ho Ghana Department of Neurology Korle-Bu Teaching Hospital Accra Ghana

Introduction: skull base osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk indi

关键词： skull base osteomyelitis Cranial Nerves Malignant Otitis Externa Bulbar Palsy Fungal Infection

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The diagnostic conundrum in necrotizing otitis externa

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2024年第1期10卷 59-65页

作者： Abiya A.Ahmed Shaan Rashid Vinay K.Gupta Neil C.Molony Keshav K.Gupta Bradford Royal Infirmary Bradford Teaching Hospitals NHS Foundation TrustWest BromwichWest YorkshireUK Sandwell and West Birmingham Hospitals NHS Trust West BromwichUK Russells Hall Hospital DudleyUK

Necrotizing otitis externa(NOE)is an aggressive and fast‐evolving infection of the external auditory canal.Late diagnoses and untreated cases can lead to severe,even fatal consequences and so early diagnosis and treatment are paramount.NOE is a notoriously challenging diagnosis to make.It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease.This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations,thus,providing an up‐to‐date picture of the multimodal approach required in the diagnosis of this disease.

关键词： diagnostic malignant otitis externa necrotizing osteomyelitis skull base osteomyelitis temporal bone osteomyelitis

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The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

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Journal of Otology 2022年第3期17卷 156-163页

作者： W.Leentje van der Meer Ahmed B.Bayoumy Josje J.Otten Jerome J.Waterval Henricus P.M.Kunst Alida A.Postma Department of Radiology&Nuclear Medicine Maastricht University Medical Centerthe Netherlands Department of Otorhinolaryngology and Head and Neck Surgery Maastricht University Medical Centerthe Netherlands Department of Otorhinolaryngology and Head and Neck Surgery Radboud Institute for Health SciencesRadboud University Medical Centerthe Netherlands School for Mental Health&Neuroscience Maastricht UniversityMaastrichtthe Netherlands Dutch Academic Alliance skull base Pathology Maastricht University Medical Center+Radboud University Medical CenterMaastricht/Nijmegenthe Netherlands

Objectives: Necrotizing external otitis(NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.Methods: Retrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns(group A) or complex spreading patterns(group B) as diagnosed by CT.Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results: 41 NEO patients were included, of which 27 patients belonged to group A(66%). The diseaserelated mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII(42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A(28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0(IQR 6.0-19.5) months.Conclusion: NEO is a severe disease, with significant mortality and morbidity(cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies(N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.

关键词： Necrotizing external otitis Malignant external otitis skull base osteomyelitis Clinical manifestation Spreading routes Antibiotic exposure Facial nerve palsy

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Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy:a report and review of literature

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Journal of Otology 2020年第3期15卷 112-116页

作者： K Devaraja Dipak Ranjan Nayak Department of Otorhinolaryngology and Head and Neck Surgery Kasturba Medical CollegeManipal Academy of Higher EducationUdupiKarnataka576104India

Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one or more of cranial nerves IX,X,XI,and XII.We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve.The patient though later on had internal jugular vein thrombosis,which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis,and later on,to aggravate the therapy.With proper blood sugar control and appropriate long term antibiotics,not only that the patient is disease free at one year follow up,but the cranial nerve deficits also recovered.Apart from sharing the clinical and management details of this patient,we have reviewed the relevant literature in the discussion,which has shed some light onto some of the interesting facts about this condition and its prognosis.

关键词： skull base osteomyelitis Malignant otitis externa Hypoglossal palsy Diabetes mellitus Internal jugular vein

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