gms | German Medical Science

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.