Ostéites de la base du crâne

Skull base osteitis (SBO) refers to rare infections, mainly including necrotizing otitis externa (NOE) of otological origin (mainly caused by Pseudomonas aeruginosa) and central skull base osteitis (CSBO) of sinusal origin, which has more varied etiologies.

Severe otalgia and persistent otorrhea, especially in elderly diabetic patients, should raise the suspicion of NOE and prompt temporal bone imaging.

Disease progression may result in neurological complications (facial nerve palsy, abscesses, empyemas, meningitis) and vascular involvement. CSBO are more insidious, often presenting with cranial nerve damage in a context of chronic headache and sinusitis. Surgery is rarely indicated. Antibiotic therapy should last for at least six weeks, and may be extended in more complex cases or when the clinical and biological response is slowly favorable, possibly guided by nuclear imaging.