#35801 Fungal osteomyelitis of TMJ and skull base caused by chronic otitis media

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Background and Aims

Chronic otitis media (COM) is an inflammatory disease of the middle ear. The symptoms of COM are ear pain, intracranial complication. Skull base osteomyelitis (SBO) may occur by transmission of infection based on COM. In this paper, we present a patient with untreated COM who was diagnosed with SBO.

Methods

A-67-year-old man visited our clinic with left TMJ pain. He had taken NSAIDs, and his symptoms had been relieved but not disappeared. CT showed no abnormal finding. But he showed familiar pain in the left TMJ. He was diagnosed with left TMJ arthralgia. After medication, the pain in the left TMJ was disappeared. 6 months later, he re-visited clinic and presented with pricking pain in the same area. CT revealed erosive change in left TMJ. He was diagnosed with left TMJ osteoarthritis and prescribed medicines including amoxicillin, ketorolac. However, his severe pain had been persisted.

Results

CRP is 49.1. A MRI showed heterogeneous enhancement in the left condyle. He was referred to ENT and left mastoidectomy was performed. When the microbial cultures of resected specimens were performed, candida was found, which led to the final diagnosis of SBO.

Conclusions

In case of atypical pain on TMJ, it is necessary to take a careful history taking. Untreated COM can spread, leading to SBO. Untreated SBO can lead to death. If COM patient has a history of systemic diseases, fungal osteomyelitis may develop up to the skull base, leading to bony change. It is important to diagnose by using CT/MRI.