CEI Medical Group
California Ear Institute
Global Hearing
California Face & Laser Institute icon

Skull Based Osteomyelitis

1. What is skull-based osteomyelitis?

Skull-based osteomyelitis is an infection of the bone or bone marrow, typically caused by bacteria or sometimes fungus. These bacteria are responsible for causing damage in the region around the ear and skull base. Skull-based osteomyelitis can be secondary to severe otitis externa (swimmers ear, also associated with exostosis), meaning that the infection begins in the lining of the ear canal and then progresses to the petrous apex. Fractures and trauma can also be a gateway for infectious bacteria to enter the bone or bone marrow.

2. What are the symptoms of skull-based osteomyelitis?

Pain, typically around the ear or eye, is an early symptom of osteomyelitis. Other symptoms include conductive hearing loss resulting from Eustachian tube dysfunction, sensorineural hearing loss secondary to inflammatory invasion of the cochleovestibular nerve, and a draining ear. Tinnitus and vertigo can also occur concurrently or independent of the hearing loss. Untreated skull based otsteomyelitis can cause facial paralysis due to inflammation around and compression of the facial nerve which runs through the temporal bone of the petrous apex.

3. How prevalent is skull-based osteomyelitis?

Osteomyelitis of the skull and associated lesions of the petrous apex are very rare. Infectious causes have decreased significantly because of improved antibiotic therapy, improved techniques in chronic ear surgery and earlier, more frequent placement of pressure equalization tubes and improved imaging studies leading to earlier diagnosis before the petrous apex is affected. The prevalence of skull-based osteomyelitis is about 1.5% of all osteomyelitis cases. Patients with compromised immune systems, (such as diabetics, those with cancer, or transplant patients) are more prone to the disease.

4. What is the treatment for skull-based osteomyelitis?

A specialized interdisciplinary team of professionals is necessary to treat all of the issues associated with Skull-based osteomyelitis. This group of individuals should include an Otologist or Otolaryngologist, and an audiologist, and possibly a vestibular rehabilitation expert if the patient’s balance is affected.

The California Ear Institute is a leading global center for otological, otolaryngological and audiological treatment. Dr. Joseph Roberson, a board certified neurotologist, has performed thousands of successful hearing related surgeries, including many on patients whose hearing impairment is the result of skull-based osteomyelitis.

5. What are the consequences of avoiding treatment?

Patients must seek medical treatment for any change in hearing or balance regardless of whether or not skull-based osteomyelitis is suspected to be the source of the hearing loss. Evaluation for beneficial drug treatment or surgery cannot be established without a comprehensive medical examination and associated testing. Avoiding medical evaluation for skull-based osteomyelitis or any other hearing or balance impairment related condition is not recommended, and can lead to permanent hearing loss, balance disturbance, or even death.

Additional Notes

Patients searching the internet for information about skull-based osteomyelitis or any other medical issue should know when reading about individual case histories, that generally it is the patients with the most severe symptoms who either post their own experiences or are included in medical review journals. As a result, it is easy to become overly alarmed and assume the worst. Patients should keep this in mind as they explore the available resources, and look for sources that are certified by HON or other reputable health reviewing organizations. As with all medical conditions, prompt treatment by experienced medical personnel give the best chance for a positive outcome.


If you suspect that you have skull-based osteomyelitis, or you have noticed a change in your hearing, consult a CEI otologist. The outlook for treatment is excellent, once the diagnosis has been made and appropriate treatment is initiated.

Click here to make an appointment with the California Ear Institute to consult with one of our board certified otologists regarding your ear-related condition.

Additional Reading

  • Osei-Yeboah C, Neequaye J, Bulley H, Darkwa A. Osteomyelitis of the frontal
    bone. Ghana Med J. 2007 Jun; 41(2):88-90.
  • Driscoll CL, Lane JI. Advances in skull base imaging. Otolaryngol Clin North
    Am. 2007 Jun; 40(3): 439-54.
  • Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck.
    Acta Otolaryngol. 2007 Feb; 127(2):194-205.
  • Bouccara D, Simon-Blancal V, Rodallec M, Cyna-Gorse F, Mosnier I, Fantin B.
    Sterkers O. Osteomyelitis of the skull base due to otologic or sinus infections 5
    cases. Ann Otolaryngol. 2007 Mar;124(1):25-32.
  • Tuon FF, Russo R, Nicodemo AC. Brain abscess secondary to frontal
    osteomyelitis. Rev Inst Med Trop Sao Paulo. 2006 Jul-Aug;48(4):233-5.
  1. http://www.emedicine.com/ENT/topic244.htm
  2. http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm

California Ear Institute