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Role of surgery and antimicrobials in refractory skull base osteomyelitis- a prospective study.
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  • Bini Faizal,
  • Lakshmi Nair,
  • Jayanthy Pavithran,
  • Merlin Moni,
  • Sheejamol VS
Bini Faizal
Amrita Institute of Medical Sciences and Research Centre

Corresponding Author:[email protected]

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Lakshmi Nair
Amrita Institute of Medical Sciences and Research Centre
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Jayanthy Pavithran
Amrita Institute of Medical Sciences and Research Centre
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Merlin Moni
Amrita Institute of Medical Sciences and Research Centre
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Sheejamol VS
Amrita Institute of Medical Sciences and Research Centre
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Abstract

Abstract Objective: To analyse the role of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). Study design and setting: A prospective comparative study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. Participants: The study population comprised 35 patients refractory to systemic antimicrobials of at least four weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. Main outcome measures: The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. Results: According to our study, relief of pain was faster in the surgical group(1.66 against 4.57 months) with statistical significance (p< 0. 001). Relief of symptoms (p< 0.001), radiological improvement (p= 0.001), and normalizing of inflammatory markers (p<0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9. 2 months in the surgical group compared to 11.3 months in the medical group (p= 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). Conclusion: The treatment response to surgery and antimicrobials in treating refractory cases of SBO was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
23 Dec 2022Submitted to Clinical Otolaryngology
28 Dec 2022Submission Checks Completed
28 Dec 2022Assigned to Editor
02 Jan 2023Reviewer(s) Assigned
28 Jun 2023Review(s) Completed, Editorial Evaluation Pending
21 Jul 2023Editorial Decision: Revise Major
04 Aug 20231st Revision Received
10 Aug 2023Submission Checks Completed
10 Aug 2023Assigned to Editor
29 Aug 2023Reviewer(s) Assigned
18 Apr 2024Review(s) Completed, Editorial Evaluation Pending
18 May 2024Editorial Decision: Accept