gms | German Medical Science

80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

Chronic osteomyelitis with epidural abscesses – a rare complication of chronic mastoiditis

Meeting Abstract

  • corresponding author Christina Klemm - Universitätsklinik, Freiburg, Germany
  • Kathrin Gollner - Universitätsklinik, Freiburg, Germany
  • Susan Arndt - Universitätsklinik, Freiburg, Germany
  • Marta Herrero y Calle - Universitätsklinik, Freiburg, Germany
  • Antje Aschendorff - Universitätsklinik, Freiburg, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno025

DOI: 10.3205/09hno025, URN: urn:nbn:de:0183-09hno0253

Published: July 22, 2009

© 2009 Klemm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: When treated insufficiently, skull base osteomyelitis has a high mortality rate although there are few generalized symptoms. Intratemporale and intracranial complications may also arise from the bottom of a latent mastoiditis.

Case report: We report about a 40-year-old-woman with chronic osteomyelitis of the temporal bone. Initially, she presented with an acute otitis media (AOM) and suffered from headache and vomiting. Her history was negative for other otological problems.

Mastoiditis was diagnosed by clinical examination. The high resolution CCT scan revealed an obstructed mastoid with bone erosion, and multiple epidural abscesses extending to the parietal-occipital skullcap. Internal bone segments were already eroded.

In interdisciplinary surgery, the temporal bone was partly resected and a mastoidectomie was performed.

The swab taken from the epidural abscesses showed Streptococcus pneumoniae. Histological investigation revealed acute destructive inflammation combined with intermittent chronic granulation. No postoperative complications occurred. A bone replacement by CAD-CAM was planned approximately 6 months after the initial operation. This case demonstrates an example where chronic mastoiditis, displaying no symptoms, caused an osteomyelitis with epidural abscesses.

Conclusion: Intratemporal and intracranial complications caused by a chronic mastoiditis are rare. High resolution CCT's are an important diagnostic tool especially if a skull base osteomyelitis is suspected. Only aggressive surgery combined with high dose antibiotic therapy according to the microbiological antibiogram can improve patient outcome.


References

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Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R. The role of the otorhinolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol. 2007;21(3):281-5.
2.
Nissen AJ, Bui H. Complications of chronic otitis media. Ear Nose Throat J. 1996;75(5):284-92.