Skull base osteomyelitis occurs most often in patients who are diabetic or immunocompromised. The usual bacterial pathogen is pseudomonas aeruginosa. Other predisposing conditions include arteriosclerosis, immunosuppression, chemotherapy, steroid use, and other immunodeficient states. The diagnosis is strongly suggested by a history of diabetes mellitus, severe otalgia, cranial neuropathies, and characteristic EAC findings.

The EAC may be filled with friable granulation tissue, which is primarily found inferiorly. Because this presentation may be identical to that of a soft tissue malignancy, prudence dictates a tissue biopsy even if a history of diabetes mellitus is present. Bare bone of the EAC floor may be exposed; small bony sequestra may be observed as well.

Computed Tomography (CT) demonstrates bone erosion, and gallium scanning can be performed at points throughout treatment to monitor resolution. Treatment consists of administration of an antipseudomonal intravenous (IV) antibiotic such as ceftazidime (in some cases) or oral ciprofloxacin (in less dramatic cases). Extended treatment for at least 6 weeks is most appropriate. Hyperbaric oxygen therapy may also be effective. Surgical debridement is reserved for granulation tissue.

Ahmed Hassan Mahmoud Khashaba has completed M.B.B.Ch at Ain Shams University in 1977. He has completed Master Degree and Medical Doctorate at Ain Shams University. He is Board member of The Egyptian Society of ORL And Head Neck Surgery”, The Egyptian Society of Head Neck Oncology”, "The Egyptian Endoscopic Surgery Group”, "The Egyptian Military Medical Academy Course of Otologic Microsurgery”. He is currently working as a Lecturer at Egyptian Military Medical Academy. His research interests are Head & Neck Surgery, Skull Base Surgery, Oto- Neurosurgery, Endoscopic Sinus Surgery & Anterior Skull Base Surgery.