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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 w