PURPOSE: To describe skull base osteomyelitis, an uncommon complication of chronic otitis media in the post-antibiotic era, as a cause for diplopia. DESIGN: Case report. METHODS: The records of a patient with skull base osteomyelitis were reviewed. RESULTS: A patient presented with a sixth nerve palsy and tenth nerve palsy. Magnetic resonance imaging, bone scan, and gallium scan were helpful in establishing the diagnosis. Cultures grew Pseudomonas. The treatment required long-term intravenous antibiotics. CONCLUSIONS: Pseudomonas skull-based osteomyelitis can produce a sixth nerve palsy as a result of the involvement of the clivus. Although uncommon in the post-antibiotic era, early recognition, appropriate diagnostic testing, and aggressive systemic antibiotic treatment might prevent permanent neurologic sequel.
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