eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Skull Base

Skull Base, Petrous Apex, Infection: Follow-up

Author: Andrea H Yeung, MD, BS, Clinical Instructor, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco
Coauthor(s): Lawrence R Lustig, MD, Professor and Francis A Sooy Chair, Department of Otolaryngology, Division Chief of Otology, Neurotology, and Skull Base Surgery, Director of UCSF Cochlear Implant Program, Co-Director of UCSF Center for Balance and Falls, University of California San Francisco
Contributor Information and Disclosures

Updated: Nov 6, 2008

Outcome and Prognosis

Although death was a common outcome of these infections in the preantibiotic era, the use of antibiotics and improved surgical techniques have dramatically improved survival rates in patients with petrous apicitis. Because of the small number of patients who present today, no large series have examined outcomes of patients with petrous apicitis. Furthermore, the widespread availability of antibiotics and improved surgical techniques in use today make comparisons with older series unhelpful.

In a series of 8 patients by Chole and Donald, 7 patients had resolution of their infection, while 1 died of infection.10 Of these patients, 1 required a reexploration for continued drainage and another had persistent deficits of CN IX-XI. The remainder experienced resolution of their otorrhea and CN deficits.

Another report of 2 patients with Gradenigo syndrome treated with antibiotics and mastoid drainage demonstrated complete recovery of CN VII with treatment in both patients.

Resolution of CN palsies typically occurs over 3-4 weeks when adequately treated. Surgery in combination with antibiotics typically results in a more rapid resolution of CN deficits than antibiotics alone.

Overall, hearing results in patients undergoing surgery for all petrous apex lesions are quite good. In a large series examining hearing results in surgery for primary petrous apex lesions, hearing was preserved in approximately one half of patients, improved in approximately one third, and worsened in 4% (1 patient of 25). Although this group presented with various lesions within the petrous apex, including cholesterol granulomas, cholesteatomas, mucoceles, and eosinophilic granulomas, it is reasonable to believe that hearing results would be comparable, if not better, in patients with apicitis.

Future and Controversies

Although surgery has historically been the mainstay of therapy, some authors are advocating IV antibiotics as a first-line therapy for petrous apicitis. These authors point out the successful treatment of certain brain abscesses with medical therapy alone, as well as some patients with petrositis whose condition resolved over a prolonged period with IV antibiotics alone. However, the authors agree that a poor clinical response to antibiotics is an indication for surgical drainage.

 


More on Skull Base, Petrous Apex, Infection

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Treatment: Skull Base, Petrous Apex, Infection
Follow-up: Skull Base, Petrous Apex, Infection
References
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References

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Further Reading

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Keywords

petrous apex, petrous apex infection, skull base infection, petrous apicitis, Gradenigo syndrome, Gradenigo's syndrome, petrositis, temporal bone

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Contributor Information and Disclosures

Author

Andrea H Yeung, MD, BS, Clinical Instructor, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco
Andrea H Yeung, MD, BS is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence R Lustig, MD, Professor and Francis A Sooy Chair, Department of Otolaryngology, Division Chief of Otology, Neurotology, and Skull Base Surgery, Director of UCSF Cochlear Implant Program, Co-Director of UCSF Center for Balance and Falls, University of California San Francisco
Lawrence R Lustig, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, North American Skull Base Society, Society for Neuroscience, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Douglas D Backous, MD, Director of Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center
Douglas D Backous, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Association for Research in Otolaryngology, North American Skull Base Society, Society for Neuroscience, and Washington State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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