Case PresentationĪ 74-year-old diabetic gentleman with chronic kidney disease presented to the Ear, Nose, and Throat Clinic with a history of prolonged ear pain and hearing loss associated with ear drainage bilaterally. We report a case of SBO occurring in a gentleman with bilateral otitis media, in the absence of external ear disease. SBO originating from the otitis media is a rare entity. This can be done by using hyperbaric therapy as an adjunct to the treatment of SBO. In addition, improving the oxygen perfusion of tissues is thought to strengthen host defenses and lead to oxidative damage of pathogens. ĭue to its aggressive nature and associated high morbidity and mortality, prolonged treatment with broad-spectrum antibiotics and possible surgical requirement is the mainstay treatment option for skull base osteomyelitis. Although the Gallium scan is the gold standard for following up patients with necrotizing otitis externa, FDG-PET/CT scan has shown to be a reliable alternative when gallium is not available. Technetium Tc 99m bone scans also allow for diagnosing bony involvement. CT scanning allows for the identification of bony erosion. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are classically seen in patients with NOE.
![external auditory meatus skull external auditory meatus skull](http://www.vhdissector.com/lessons/cadaver-dissection-guide/head-and-neck/bones/images/skull-anterior-interior-internal-auditory-meatus.png)
![external auditory meatus skull external auditory meatus skull](https://assets.neurosurgicalatlas.com/neuroanatomy/Rhoton/Rhoton0102.jpg)
Diagnosis of NOE is based on history, physical examination, inflammatory markers, and radiological studies. Lateral skull base osteomyelitis (SBO), otherwise known as necrotizing otitis externa (NOE), is a severe invasive infection of the external auditory canal, temporomandibular joint, and skull base, which occurs by spread from the external ear canal through the fissures of Santorini and the osseocartilaginous junction.