Skull Base Osteomyelitis in the Auckland Region
Authors List
Emanuel, Henry., Waikato Hospital, Hamilton, New Zealand
Neeff, Michel,. Auckland Hospital, Auckland, New Zealand
Thomas, Mark,. Auckland Hospital, Auckland, New Zealand
Introduction: Skull Base Osteomyelitis (SBO) has continued for decades to provide us challenges in diagnosis, treatment, and surveillance of disease.
Aims: To identify factors that predict worse outcome in this disease, and to scrutinise the performance of nuclear medicine scans and inflammatory markers to assess for disease resolution.
Methods: A retrospective review of cases between 2004 and 2019 presenting with SBO in the Auckland region was performed. A series of chi-square tests were performed to assess for association between radiologic outcome, inflammatory outcome, smoking status, facial palsy, diabetes and the clinical outcome after the first planned treatment regimen. Microbiology samples were assessed with respect to their relative yeild depending on the site of sampling. Two recent studies' severity scoring systems were used to test thier ability to predict clinical outcomes in our cohort.
Results: 63 new cases of SBO were assessed, and the annual rate increased over the study period. Pacific Island people were siginificantly overrepresented. Pseudomonas aeruginosa was the predominant pathogen but a wide range of microbes were cultured. Samples from the mastoid cavity were surprisingly unhelpful, with a majority of patients having adequate tissue sampling from the ear canal under local anaesthetic.The overall success of treatment was seen in 44 patients (69.8%). Positive gallium scan and raised c-reactive protein (CRP) at the conclusion of treatment were significantly associated with clinical failure (p<0.05 and p<0.01 respectively). The sensitivity and specificity of gallium scans to predict clinical resolution is 69% and 84% respectively. Predictors as described in Stern Shavit et al (age>70, positive CT scan, diabetes) were significant predictors of failure over success. Logisitic regression analysis of clinical variables outlined by Stevens et al demonstrated a positive association with clinical outcomes, but not with radiographic variables.
Conclusions: Our findings support a combination of clinical, radiographic, and inflammatory measures to determine cure in SBO.
Emanuel, Henry., Waikato Hospital, Hamilton, New Zealand
Neeff, Michel,. Auckland Hospital, Auckland, New Zealand
Thomas, Mark,. Auckland Hospital, Auckland, New Zealand
Introduction: Skull Base Osteomyelitis (SBO) has continued for decades to provide us challenges in diagnosis, treatment, and surveillance of disease.
Aims: To identify factors that predict worse outcome in this disease, and to scrutinise the performance of nuclear medicine scans and inflammatory markers to assess for disease resolution.
Methods: A retrospective review of cases between 2004 and 2019 presenting with SBO in the Auckland region was performed. A series of chi-square tests were performed to assess for association between radiologic outcome, inflammatory outcome, smoking status, facial palsy, diabetes and the clinical outcome after the first planned treatment regimen. Microbiology samples were assessed with respect to their relative yeild depending on the site of sampling. Two recent studies' severity scoring systems were used to test thier ability to predict clinical outcomes in our cohort.
Results: 63 new cases of SBO were assessed, and the annual rate increased over the study period. Pacific Island people were siginificantly overrepresented. Pseudomonas aeruginosa was the predominant pathogen but a wide range of microbes were cultured. Samples from the mastoid cavity were surprisingly unhelpful, with a majority of patients having adequate tissue sampling from the ear canal under local anaesthetic.The overall success of treatment was seen in 44 patients (69.8%). Positive gallium scan and raised c-reactive protein (CRP) at the conclusion of treatment were significantly associated with clinical failure (p<0.05 and p<0.01 respectively). The sensitivity and specificity of gallium scans to predict clinical resolution is 69% and 84% respectively. Predictors as described in Stern Shavit et al (age>70, positive CT scan, diabetes) were significant predictors of failure over success. Logisitic regression analysis of clinical variables outlined by Stevens et al demonstrated a positive association with clinical outcomes, but not with radiographic variables.
Conclusions: Our findings support a combination of clinical, radiographic, and inflammatory measures to determine cure in SBO.
