Introduction:
Skull base osteomyelitis (SBO) is an invasive infection in which pathogens spread to the periosteum of the temporal bone and tissue planes, causing necrosis. Chandler coined the term malignant otitis externa (MOE) in 1968.1 Synonyms like necrotizing otitis externa, temporal bone osteomyelitis, and SBO also are used. SBO accurately describes the pathophysiology of the disease.2 In atypical or central SBO, sphenoid and occipital bones are affected.3 The disease commonly affects people with diabetes with poor chemotaxis, phagocytosis, and humoral immunity.4 Diagnosis is from clinical features, culture, histopathology, and imaging modalities like CT and MRI scans. PET CT and PET MRI having a superior spatial resolution, less radioactivity, and higher sensitivity and specificity, have been preferred lately over other nuclear scans to diagnose and determine the resolution of SBO. 5- 8
When initially described by Chandler, the treatment was mainly surgical, along with antibiotics like Colistin or Polymixin, with a mortality of 46%.1 With broad-spectrum antibiotics, surgical interventions have become a rarity, and mortality has reduced to 10%. With the emergence of refractory cases probably due to multidrug-resistant strains, fungal pathogen, and lack of positive culture, the role of surgery is being considered by many centres to shorten the hospital stay and duration of treatment.9While antimicrobials and polypharmacy pose problems in treating these elderly immunocompromised patients, surgery may increase morbidity further. The role of surgery in the treatment of refractory SBO forms the study’s objective.