Atypical Presentation of Skull Base Osteomyelitis Involving the Stylomastoid Foramen—A Case Report

An atypical presentation of skull base osteomyelitis (SBO) involving the stylomastoid foramen in a diabetic individual without facial palsy or positive otoscopic ear findings has been presented. Method A case report of a 78 year old poorly controlled diabetic male who had severe ear pain without otoscopic ear findings and was treated prior with IV antibiotics for a period of two months without relief was referred to our tertiary care Center and was operated by us following which he had complete relief of symptoms. Result SBO presenting without otoscopic ear findings or facial nerve palsy at the region of the stylomastoid foramen is extremely rare. High-resolution computed tomography/Magnetic resonance imaging form the main modalities for investigations to diagnose this condition. SBO not responding to more than 6 weeks of IV antibiotics requires surgical debridement/sequestrectomy/drainage of the abscess to relieve patient symptoms. Conclusion Skull base osteomyelitis secondary to Malignant Otitis Externa usually presents with ear pain, discharge and otoscopic ear findings viz. granulation at floor of canal at bony cartilaginous junction however atypical presentations such as this case can pose diagnostic challenges and treatment dilemmas in the absence of any otoscopic ear findings except pain over the temporal bone and headache.