Author(s)
Hetal Lad, BS
Emma Thompson, BA
Lucy Revercomb, BS
Joseph Chong, BS
Devanshi Patel, MD
Michael Ray Moentmann, MD
Ayushi Chadha
Yu-lan Mary Ying, MD
Affiliation(s)
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
Abstract:
Objective:
Skull base osteomyelitis (SBO) is a rare but life-threatening complication of malignant otitis externa. Mainstay treatment is intravenous antimicrobials. The role of surgical intervention, namely mastoidectomy with ear tube placement, for intraoperative tissue culture remains unclear. We aim to characterize the role of surgery in facilitating culture-directed antimicrobial therapy and associated outcomes in SBO management.
Study Design:
Retrospective chart review.
Setting:
Tertiary academic healthcare system.
Patients:
Patients treated for SBO at Rutgers Health between 2011 and 2025.
Intervention(s):
Mastoidectomy with pressure-equalization tube placement for intraoperative tissue culture.
Main Outcome Measure(s):
Antibiotic regimen modification following culture results and subsequent disease recurrence.
Results:
A total of 62 patients with a mean age of 68.5 years (77.4 % male) met inclusion criteria. Surgery was performed in 75.8% (47/62) of patients, with surgical cultures obtained from the external auditory canal (EAC) (51.6%), middle ear (16.1%), and mastoid (37.1%). EAC cultures were obtained for 87.5% of patients who did not undergo surgery. Positive cultures were identified in 69.3% of surgical specimens, most commonly Candida species (20%), Pseudomonas aeruginosa (15%), and Staphylococcus epidermidis (15%). Initial antimicrobial regimens were modified based on surgical culture results in 64.5% of cases (p=0.01). Among patients receiving antimicrobials modified after surgical culture, the recurrence rate was 25% (6/24), compared to 31.3% (5/16) in those receiving antibiotics that did not change (p = 0.37). The mean time to recurrence differed by 36.5 days between those with modification of antimicrobials compared to maintenance (89 vs 52.5 days, respectively) (p=0.34).
Conclusions:
Mastoid surgery for tissue analysis provided high therapeutic yield, prompting antibiotic modification in patients with SBO. Surgery may provide diagnostic benefit through tissue sampling to guide early targeted antimicrobial selection.
Learning Objective: To understand the diagnostic and therapeutic role of surgery in guiding antimicrobial therapy and improving clinical outcomes in skull base osteomyelitis.
Desired Result: Clinicians will recognize the value of surgical tissue culture collection in enabling targeted antimicrobial modification and reducing disease recurrence in patients with skull base osteomyelitis.
Level of Evidence - III
Indicate IRB or IACUC: Pro2024002225