목적: Otogenic skull base osteomyelitis (SBO) is a life threatening disease. It can be originated from malignant external otitis(MEO) or chronic otitis media(COM). The aim of this study was to compare the clinical manifestations of SBO according to the origin of infection MEO and COM. 방법:Total 20 patients with SBO were retrospectively reviewed. According to the origin of infection (MEO vs. COM), demographics, symptoms, and clinical courses were compared. 결과:Number of patients with SBO associated with MED and COM was 11 and 9, respectively. Mean age of patients was 68 years in SBO with MED and 61.8 years in SBO with COM. In patients with SBO, most common initial symptom was otalgia (55%), followed by facial palsy and otorrhea (35%). Eleven (55%) patients presented cranial nerve palsy (mainly facial nerve palsy), which SBO with COM is more common (n=4). Identified microbes were MRSA (n=6, 30% ), P. aeruginosa (n=3, 15%), Candida (n=2, 10%), and culture negative (n=9, 45%). In COM patients, MRSA was the most common pathogen (n=3, 30% ). Otherwise Pseudomonas was most common (n=3, 27.2%) in MEO. Culture negative was 33.3% in COM, 45.5% in MEO. All patients were treated with IV antibiotics, and mean periods of IV antibiotics treatment were 5 weeks (maximum 64weeks). Treatment response was evaluated by patients symptoms, infection marker (CRP or ESR), and extent of disease by MRI imaging. Overall successful treatment outcomes according to patients symptoms, infection marker (CRP or ESR), and extent of disease by MRI were 65%, 55% and 50%, respectively. The patients with SBO with COM had better prognosis than SBO with MEO. 결론:The patients with SBO originating from COM showed different clinical manifestations from SBO with MEO. For proper management of SBO, complete search of infection origin and adequate treatment with optimal antibiotics should be considered.