Skull base infection presenting with multiple lower cranial nerve palsies

Diseases of the temporal bone causing lower cranial nerve palsies are uncommon. In the presence of bony erosion, they are highly suggestive of a malignant process. However, when there is a clear history of otitis externa in an immunocompromised or diabetic patient, a diagnosis of osteomyelitis and secondary inflammatory mass should be considered. We report 4 separate cases of infective skull base lesions causing multiple lower cranial nerve palsies in elderly patients who were not immunocompromised or diabetic, highlighting that this condition is not exclusive to this population.