Chronic nonbacterial osteomyelitis

PURPOSE OF REVIEW: Chronic nonbacterial osteomyelitis encompasses a spectrum of sterile bony inflammatory lesions that are incompletely understood and not well known in the otolaryngology community. RECENT FINDINGS: Current research is investigating the underlying immunologic mechanisms postulated to be responsible for chronic nonbacterial osteomyelitis. Disruption in the innate balance between proinflammatory and anti-inflammatory cytokines is currently felt to be responsible, with several specific pathways identified as potential targets for treatment. Additionally, Propionibacterium sp. and other infectious organisms are now felt to be triggers of inflammation, rather than true causative agents. SUMMARY: Nonsteroidal anti-inflammatory medications remain the first-line treatment for this condition. Additional medical therapy, such as glucocorticoids, can be indicated in refractory cases. Surgical options are available for recalcitrant situations, although the potential for recurrence after surgery remains, as the underlying mechanism has not been addressed with surgery alone.