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The atypical presentations of skull base osteomyelitis pose a diagnostic challenge. This case highlights that even otitis media is a potentially fatal infection in older patients with diabetes. Early diagnosis and aggressive management of skull base osteomyelitis are of upmost importance and will ensure a more favorable prognosis. Crista galli is extremely important in the endoscopic transcribriform approaches and some extradural approaches. Because of its clinical significance, the morphometric properties of crista galli should be well kn