The challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice
Autor: | Isabella Stanisz, Alice B. Auinger, Valerie Dahm, Christoph Arnoldner, Ursula Schwarz-Nemec |
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Rok vydání: | 2021 |
Předmět: |
Necrotizing otitis externa
medicine.medical_specialty Otology Skull base osteomyelitis 03 medical and health sciences 0302 clinical medicine Malignant otitis externa medicine Humans 030223 otorhinolaryngology Skull Base business.industry Mortality rate Osteomyelitis General Medicine Otitis Externa medicine.disease Discontinuation Functional imaging Otorhinolaryngology Radiology Neurosurgery Tomography X-Ray Computed business Complication Cranial nerve palsy 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | European Archives of Oto-Rhino-Laryngology |
ISSN: | 1434-4726 0937-4477 |
DOI: | 10.1007/s00405-020-06576-6 |
Popis: | Purpose The disease activity of skull base osteomyelitis can be challenging to assess by means of conventional imaging methods and renders monitoring of the disease difficult, especially in areas with restricted access to nuclear medicine imaging. Here, we provide clinically relevant data on the management of skull base osteomyelitis including assessment, treatment, and follow-up strategies with regards to the role of imaging. Method A chart review was performed including 30 patients treated for SBO from 1993 to 2015. Clinical findings, treatment procedures, and complication rates were assessed. Special attention was paid to imaging procedures. Results The overall mortality rate was 36.7% and increased to 45% when cranial nerve palsies were present. An initial computed tomography (CT) scan was performed in all patients, MRI in 60% and nuclear imaging in 33%. CT scans failed to detect progression or regression in up to 80% after four to nine months. MRI examinations could reveal changes at a higher rate compared to CT. Nuclear medicine functional imaging was most likely to assess disease activity. Conclusion A combination of different imaging modalities is recommended for diagnosing SBO. For the follow-up, MRI is preferable to CT as changes can be detected more readily with MRI. If available, nuclear medicine imaging should guide the decision of treatment discontinuation. |
Databáze: | OpenAIRE |
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