SBO may be classified as:
(1) typical, associated with malignant otitis externa and involving the temporal bone
(2) atypical, not due to malignant otitis media and/or involving the sphenoid or occipital bone
General features of SBO:
(1) headache
(2) cranial nerve palsy (ranging from facial nerve palsy to any combination of CN 6 to 12 involvement including Villaret's syndrome)
(3) bone destruction on imaging studies
(4) one or more risk factors (see previous sections -diabetes, immunosuppression, etc)
A patient with typical SBO will have one or more symptoms referring to the ear (history of recent otitis, inflammation of external ear, cellulitis, etc).
A patient with atypical SBO may have a history of sinusitis or may have no other finding.
It is essential:
(1) to consider the diagnosis if any of the general features are present
(2) to obtain culture material if possible to help confirm the diagnosis and to help guide therapy
(3) to exclude a malignancy or other cause
