Skull Base Osteomyelitis in Children: Clinical Characteristics and Potential Implications
2Pediatric Infectious Disease Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, ישראל
3Pediatric Radiology, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, ישראל
4Day-Care Hospitalization, Schneider Children’s Medical Center, ישראל
Objectives: We describe 10 new cases of otogenic (n = 8) and non otogenic (n = 2) skull base osteomyelitis (SBO) in previously healthy children and review the literature on SBO in the pediatric population.
Methods: We retrospectively analyzed the medical records of 10 children (age range 0.9-12.8 years) ddischarged with a diagnosis of SBO between 2015 and 2020 in two children`s hospitals in central Israel .
Results: Five patients presented with fever and five with otological signs and symptoms. All 10 children underwent a comprehensive clinical evaluation, imaging studies (computerized tomography [CT] or magnetic resonance imaging [MRI]) and laboratory investigations. The physical examination revealed neurologic findings, including nuchal rigidity, papilledema and apathy, in 4 patients. All 8 otogenic patients underwent surgical intervention and the 2 non-otogenic patients, who were diagnosed as having deep neck and throat infections, responded well to treatment consisting of antibiotics without surgery
Conclusions: Early diagnosis of pediatric SBO can be challenging since the symptoms are often nonspecific. The final diagnosis relies mainly upon imaging, preferably MRI. Surgical intervention is usually mandatory in the otogenic patients, while the non-otogenic patients respond well to medical management alone.