2015 Volume 58 Issue 6 Pages 297-303
Skull base osteomyelitis is a condition characterized by osteomyelitis of the base of the skull and the temporal bone. This disease occurs under the direct influence of inflammation that has occurred in the external auditory meatus and middle ear, the paranasal sinuses or by hematogenous influence from some remote organs. We report herein on a case of skull base osteomyelitis which presented difficulty in differentiation from a nasopharyngeal carcinoma. The patient was a 66-year-old man who presented with left earache. At a neighborhood medical clinic, he was treated as having acute otitis media but his symptoms were getting worse. Several examinations that included computed tomography and magnetic resonance imaging were performed at the clinic. As a result, a nasopharyngeal tumor was suspected based on some of the examinations, and he was referred to our hospital. We performed a biopsy on several occasions. There were no malignant views. However, the patient started to complain of a headache in addition to the earache, and those symptoms showed a tendency to worsen. Accordingly, we performed a biopsy under general anesthesia. At this biopsy, we gathered many specimens from considerably deep sites, following which a discharge of much pus occurred from the deep biopsy sites. We therefore subjected the biopsies to culture and gram staining. No malignant views were seen at all. After the biopsy, the patient's earache and headache were improved significantly. We were unable to identify the causative agent, but we diagnosed the condition as skull base osteomyelitis based on some of the results of our examination, and we started him on appropriate therapy. Following a 6-week antibiotic treatment, he currently does not have any recurrence of the illness.
Skull base osteomyelitis is a disease associated with a poor convalescence, so we must diagnose this disease early. Therefore, there are some cases which might suffer from a misdiagnosis, for example a case with difficulty in differentiation from nasopharyngeal carcinoma, or a case which is culture negative. We should thus perform a biopsy under general anesthesia to arrive at a positive diagnosis.
