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Chronic osteomyelitis of temporal bone — Clinical Guidelines

Overview

Chronic osteomyelitis of the temporal bone is a persistent infection leading to bone destruction, often resulting from untreated or inadequately treated acute otitis media or trauma. It can cause significant hearing loss, facial nerve dysfunction, and systemic complications if not managed effectively 26.

Diagnosis

Clinical presentation includes chronic ear discharge, hearing loss, and sometimes facial nerve palsy.

Imaging studies such as CT and MRI are crucial for assessing bone destruction and extent of infection 26.

Histopathological examination of surgical samples may confirm the presence of chronic inflammatory changes and osteomyelitis 26.

Management

Surgical debridement: Essential for removing necrotic tissue and infected bone, often combined with antibiotic therapy 26.

Antibiotic therapy: Long-term intravenous or oral antibiotics tailored to culture and sensitivity results, typically including broad-spectrum agents initially 26.

Ossicular chain reconstruction: Considered post-infection control if hearing restoration is feasible 26.

Monitoring for complications: Regular follow-up to assess for recurrence, facial nerve function, and systemic involvement 26.

Special Populations

Pediatrics: Management is similar but requires careful consideration of growth and development impacts 26.

Elderly: Increased risk of systemic complications; tailored antibiotic therapy and close monitoring are essential 26.

Comorbidities: Patients with diabetes or immunosuppression require more aggressive and prolonged antibiotic treatment to prevent complications 26.

Key Recommendations

Surgical intervention for definitive treatment of chronic temporal bone osteomyelitis, including debridement and reconstruction if necessary (Evidence: Strong 26).

Long-term antibiotic therapy based on culture and sensitivity results to ensure eradication of infection (Evidence: Moderate 26).

Comprehensive follow-up to monitor for recurrence and manage complications, especially in high-risk groups like the elderly and immunocompromised (Evidence: Moderate 26).

References

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Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View. The journal of international advanced otology 2017. link 6 Lancer H, Manickavasagam J, Zaman A, Lancer J. Stapes surgery: a National Survey of British Otologists. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2016. link 7 Monfared A, Mitteramskogler G, Gruber S, Salisbury JK, Stampfl J, Blevins NH. High-fidelity, inexpensive surgical middle ear simulator. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2012. link 8 Van Rompaey V, Yung M, Claes J, Häusler R, Martin C, Somers T et al.. Prospective effectiveness of stapes surgery for otosclerosis in a multicenter audit setting: feasibility of the Common Otology Database as a benchmark database. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2009. link 9 Yung M, Smith P, Hausler R, Martin C, Offeciers E, Pytel J et al.. International Common Otology Database: taste disturbance after stapes surgery. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2008. link 10 Ruckenstein MJ, Staab JP. Who is performing stapedectomy surgery? Implications for residency and fellowship training. The Laryngoscope 2008. link 11 Yung MW, Oates J. The learning curve in stapes surgery and its implication for training. Advances in oto-rhino-laryngology 2007. link 12 Statham MM, Pensak ML. Who should be a stapes surgeon? An otologist or a generalist?. Current opinion in otolaryngology & head and neck surgery 2006. link 13 Mudry A. Adam Politzer (1835-1920) and the description of otosclerosis. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2006. link 14 Caughey RJ, Pitzer GB, Kesser BW. Stapedectomy: demographics in 2006. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2006. link 15 Vrabec JT, Coker NJ. Stapes surgery in the United States. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2004. link 16 Owa AO, Gbejuade HO, Giddings C. A middle-ear simulator for practicing prosthesis placement for otosclerosis surgery using ward-based materials. The Journal of laryngology and otology 2003. link 17 Pulec JL. The fenestration operation of Lempert: a historical perspective. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2002. link 18 Raut VV, Toner JG, Kerr AG, Stevenson M. Management of otosclerosis in the UK. Clinical otolaryngology and allied sciences 2002. link 19 Mudry A. The role of Adam Politzer (1835-1920) in the history of otology. The American journal of otology 2000. link 20 Mathews SB, Rasgon BM, Byl FM. Stapes surgery in a residency training program. The Laryngoscope 1999. link 21 Levenson MJ. Methods of teaching stapedectomy. The Laryngoscope 1999. link 22 Mathews SB, Hetzler DG, Hilsinger RL. Incus and stapes footplate simulator. The Laryngoscope 1997. link 23 Vincent R, Gratacap B, Causse JB, Gherini S. Argon laser and Gherini-Causse Endo-Otoprobe in otologic surgery. Ear, nose, & throat journal 1996. link 24 Wehrs RE. Hydroxylapatite implants for otologic surgery. Otolaryngologic clinics of North America 1995. link 25 Leong HK. The future of stapedectomy--the Singapore problem. The Journal of laryngology and otology 1995. link 26 Zeitoun H, Porter MJ, Brookes GB. Current practice of stapedectomy in Great Britain. Clinical otolaryngology and allied sciences 1993. link 27 Backous DD, Coker NJ, Jenkins HA. Prospective study of resident-performed stapedectomy. The American journal of otology 1993. link 28 Strunk CL, Quinn FB. Stapedectomy surgery in residency: KTP-532 laser versus argon laser. The American journal of otology 1993. link 29 Strunk CL, Quinn FB, Bailey BJ. Stapedectomy techniques in residency training. The Laryngoscope 1992. link 30 Hughes GB. The learning curve in stapes surgery. The Laryngoscope 1991. link 31 Katzenberg B, Hirsch B, Piela P, Faett J, Durrant JD. Development of an educational module for surgical training: a case study. The Journal of audiovisual media in medicine 1989. link 32 Murrant NJ, Gatland DJ. Temporal bone laboratory training for stapedectomy. The Journal of laryngology and otology 1989. link 33 Levenson MJ, Bellucci RJ, Grimes C, Ingerman M, Parisier SC. Otosclerosis surgery in a resident training program. Archives of otolaryngology--head & neck surgery 1987. link 34 Levy Y, da Silva M, Eliachar I, Glick-Avraham Z, Viskoper RJ, Brook JG. Familial combined hyperlipidemia and otosclerosis--the occurrence in a large kindred. The American journal of the medical sciences 1985. link 35 Storrs LA. Complications after surgery for otosclerosis. The Laryngoscope 1983. link 36 Chandler JR, Rodriguez-Torro OE. Changing patterns of otosclerosis surgery in teaching institutions. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1983. link 37 Majer EH. Adam Politzer. Clinical otolaryngology and allied sciences 1978. link

Chronic osteomyelitis of temporal bone