Janakiram T N, Kumar G Arun, Venkatramanan Mansi A R, Sampath Soumya, Sathyanarayanan J D
Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
Indian J Otolaryngol Head Neck Surg. 2025 Jan;77(1):430-435. doi: 10.1007/s12070-024-04877-4. Epub 2024 Oct 26.
An atypical presentation of skull base osteomyelitis (SBO) involving the stylomastoid foramen in a diabetic individual without facial palsy or positive otoscopic ear findings has been presented. A case report of a 78 year old poorly controlled diabetic male who had severe ear pain without otoscopic ear findings and was treated prior with IV antibiotics for a period of two months without relief was referred to our tertiary care Center and was operated by us following which he had complete relief of symptoms. SBO presenting without otoscopic ear findings or facial nerve palsy at the region of the stylomastoid foramen is extremely rare. High-resolution computed tomography/Magnetic resonance imaging form the main modalities for investigations to diagnose this condition. SBO not responding to more than 6 weeks of IV antibiotics requires surgical debridement/sequestrectomy/drainage of the abscess to relieve patient symptoms. Skull base osteomyelitis secondary to Malignant Otitis Externa usually presents with ear pain, discharge and otoscopic ear findings viz. granulation at floor of canal at bony cartilaginous junction however atypical presentations such as this case can pose diagnostic challenges and treatment dilemmas in the absence of any otoscopic ear findings except pain over the temporal bone and headache.
本文报道了一例糖尿病患者的不典型颅底骨髓炎（SBO），病变累及茎乳孔，无面瘫或耳镜检查阳性发现。一名78岁血糖控制不佳的男性糖尿病患者，耳部剧痛但耳镜检查无异常，此前接受了两个月的静脉抗生素治疗但症状未缓解，遂转诊至我们的三级医疗中心，我们为其进行了手术，术后症状完全缓解。茎乳孔区域无耳镜检查异常或面神经麻痹表现的SBO极为罕见。高分辨率计算机断层扫描/磁共振成像为诊断该疾病的主要检查手段。静脉抗生素治疗超过6周无效的SBO需要进行手术清创/死骨切除术/脓肿引流以缓解患者症状。继发于恶性外耳道炎的颅底骨髓炎通常表现为耳痛、耳漏和耳镜检查异常，即骨软骨交界处耳道底部有肉芽组织，然而，像本病例这样的非典型表现，在除颞骨疼痛和头痛外无任何耳镜检查异常的情况下，可能会带来诊断挑战和治疗困境。
