Case Report Clinical Challenges in the Diagnosis and Treatment of Temporal Bone Osteomyelitis Liubov Kornilenko, 1 Saulius Rocka, 2 Svajunas Balseris, 3 and Irina Arechvo 3 1 Faculty of Medicine, Vilnius University, Ciurlionio 21/27, LT-03101 Vilnius, Lithuania 2 Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Siltnamiu 29, LT-04130 Vilnius, Lithuania 3 Department of Ear, Nose and Troat Diseases, Republican Vilnius University Hospital, Siltnamiu 29, L T-04130 Vilnius, Lithuania Correspondence should be addressed to Irina Arechvo; arechvo@gmail.com Received 26 December 2016; Revised 21 February 2017; Accepted 26 March 2017; Published 9 April 2017 Academic Editor: Holger Sudhof Copyright © 2017 Liubov Kornilenko et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Temporal bone osteomyelitis is a serious life-threatening condition—a quick and proper diagnosis is needed to start treatment and reduce morbidity and mortality. Changing trends of the disease make a diferential diagnosis difcult. To emphasize the importance of a clinical suspicion of this dangerous condition, our experience with three difcult cases is presented. Te diagnosis was based on clinical symptoms, otoscopic fndings, and fndings on computed tomography or magnetic resonance imaging. Neoplasm and granulomatous infammation were excluded by multiple biopsies. Te disease can develop in nondiabetic patients. Te disorder might be related to the initial infammatory process in the middle ear with further direct spreading of infection through defects in the bony walls to deep temporal bone structures. Imaging should be performed early to detect osteolytic lesions of the skull base. Surgery was used for the presence of bone sequestra and infratemporal abscess. Tis manuscript is dedicated to the memory of a great, internationally renowned, otoneurologic surgeon and researcher John K. Niparko, MD 1. Introduction Temporal bone osteomyelitis (TBO) is a dangerous condition, and the proper treatment at the appropriate time is extremely important. Fatal cases of temporal bone osteomyelitis have been described previously. In the past, its cause was almost always necrotizing external otitis (NEO), especially in older adults with diabetes mellitus (DM) and patients with immunosuppressive conditions [1, 2]. Te other rare etiologic conditions also mentioned in the literature are an infection of the middle ear or previous mastoidectomy [3–5]. Changing trends in the clinical picture of the disease, including a declin- ing prevalence of DM and atypical causative agents, have been reported recently [6]. In the current manuscript, we present our experience with three diagnostically difcult cases of the disease to highlight this dangerous condition. We also noticed some new clinical details in the histories of our patients. Te charts of the patients diagnosed with TBO and treated at the Department of Ear, Nose and Troat Diseases of Republican Vilnius University Hospital from December 2013 to August 2014 were retrospectively analyzed. Te diagnosis was based on the following criteria: persistent otalgia and otorrhea; granulation tissue in the external auditory canal (EAC) and/or tympanic cavity; the tumor and specifc infammation were excluded by the multiple biopsies; typical fndings on computed tomography (CT) or magnetic resonance imaging (MRI). Demography, bacteriology, comorbid diseases, and imaging data were systematically reviewed. 2. Case Report One A 64-year-old man presented to the tertiary referral hospital with a 1-month history of severe otalgia, constant otorrhea, and a 1-week history of facial weakness on the lef side. He also complained of painful mastication on the same side. He Hindawi Case Reports in Otolaryngology Volume 2017, Article ID 4097973, 8 pages https://doi.org/10.1155/2017/4097973