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CT findings in temporal bone sites in skull base osteomyelitis from malignant otitis externa

  • Otology
  • Published:
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Abstract

Objectives

To identify the earliest sites and spread patterns of bony erosions on high-resolution temporal bone computerized tomographic (HRTBCT) scans and conjugate the radiological findings with clinical/laboratory data for guiding the interpretation of CT images of skull base osteomyelitis (SBOM) from malignant otitis externa (MOE).

Study design

Retrospective and prospective medical records analysis.

Methods

The medical records of all patients who presented to a referral medical center during 2015–2022 and initially diagnosed with SBOM. Radiological assessment of each sub-site was performed by 2 qualified neuro-radiologist, who were blind to the clinical data.

Results

33 patients were enrolled. All patients suffered edema and exudates of the external auditory canal (EAC). The most common osseous markers for SBOM were dehiscence or irregularity of the anterior EAC wall and temporomandibular joint (TMJ) medial wall (21/33, 64% patients, each), followed by a fistula from the TMJ to the EAC (20/33, 61% patients). Eustachian tube bony walls and condylar irregularity and/or dehiscence were as prevalent as 16/33, 48% of patients, each. EAC inferior and posterior walls of the EACs were irregular or dehiscent in patients with more advanced disease.

Conclusions

The high symptomatologic overlap between SBOM and other aural pathologies might cause diagnostic (and subsequent treatment) delay and result in dire complications. EAC edema and irregularity or dehiscence of the anterior EAC wall are the most common early CT findings associated with SBOM caused by MOE.

Level of evidence

4.

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Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

There are no financial interests, arrangements, or payments to disclose.

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel

    Ophir Handzel, Rani Abu Eta, Yahav Oron, Nidal Muhanna & Omer J. Ungar

  2. Department of Radiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Adi Brenner & Genady Shendler

  3. Department of Infectious Diseases, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Michal Dekel

  4. Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium

    Oren Cavel

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  1. Adi Brenner
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  2. Oren Cavel
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Corresponding author

Correspondence to Omer J. Ungar.

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Ethical approval

This retrospective medical records review was approved by the institutional review board (0312-19-TLV) of the Tel Aviv Sourasky Medical Center, which waived informed consent for this anonymized analysis.

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Brenner, A., Cavel, O., Shendler, G. et al. CT findings in temporal bone sites in skull base osteomyelitis from malignant otitis externa. Eur Arch Otorhinolaryngol 280, 2687–2694 (2023). https://doi.org/10.1007/s00405-022-07749-1

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  • DOI: https://doi.org/10.1007/s00405-022-07749-1

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