Managing Skull Base Osteomyelitis: A Case of Concurrent Bacterial and Fungal Infections in the Ear

Background: Skull base osteomyelitis is a severe infection with a high risk of complications, particularly in immunocompromised individuals over 65. It often originates from nearby tissue infections and can progress to neuroinfections. In cases of malignant otitis externa, inflammation may extend to the cartilages through Santorini fissures and the tympanomastoid suture, leading to osteitis of the temporal bone. Initial symptoms typically include otalgia, headache, ear discharge, and conductive hearing loss. Involvement of the stylomastoid foramen can cause facial nerve palsy, while inflammation of the jugular foramen may lead to paralysis of lower cranial nerves. Management generally involves prolonged antibiotic therapy and surgical debridement of infected tissues. Observations/Results: A patient with chronic suppurative otitis media in the right ear was diagnosed with bacterial skull base osteomyelitis and fungal skull base osteomyelitis concurrently. Due to the severity of the fungal infection, the patient was urgently referred to a specialized skull base surgeon for surgical debridement. This procedure aims to remove infected tissue and prevent further complications. Discussion and Conclusions: Early and accurate diagnosis is crucial for effective management of skull base osteomyelitis. Timely intervention helps prevent disease progression and reduces morbidity and mortality.