1/56. Congenital malformation of the inner ear associated with recurrent meningitis.Congenital deformities of the labyrinth of the inner ear can be associated with meningitis and varying degrees of hearing loss or deafness. A recurrence of meningitis is due to the development of a fistulous communication between the subarachnoid space and the middle ear cavity, and can prove lethal. An illustrative case of a 4-year-old Japanese girl with bilateral severe hearing loss, recurrent meningitis and malformations of the inner ear and stapes footplate is presented. Removal of the stapes during tympanotomy provoked a gush of cerebrospinal fluid. The defect was repaired successfully, and there has been no further episodes of meningitis to date.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/56. Recurrent meningitis in the pediatric patient--the otolaryngologist's role.OBJECTIVE: To assess the etiology of recurrent meningitis in the pediatric patient. DESIGN: Retrospective case series and literature review. SETTING: Tertiary-care pediatric hospital. patients: Children (< 17-years-old) with recurrent meningitis, treated at texas Children's Hospital (TCH) between 1984 and 1995. RESULTS: A review of 463 cases of bacterial meningitis over an 11 year period revealed six children aged 3 months to 15 years with the diagnosis of recurrent meningitis. The patient's age, number of episodes of meningitis, diagnostic investigations performed and etiologies of recurrent meningitis were recorded. Fifteen episodes of meningitis were identified in these six patients; streptococcus pneumoniae represented the bacteriology in 73% of the cases. Two patients were diagnosed with temporal bone abnormalities, two children with immunological deficiencies and no underlying etiology for the recurrent meningitis was identified in the remaining two patients. In this series, one-third of patients had an otolaryngologic etiology for their recurrent meningitis. These six patients, along with a review of the recent literature, will highlight the need for otolaryngological assessment and the importance of considering immunological investigations when managing recurrent meningitis in the pediatric patient. CONCLUSION: We propose that children with recurrent meningitis of unknown etiology undergo: (1) an audiological evaluation; (2) a CT scan of the temporal bones, skull base and paranasal sinuses; and (3) an immunological evaluation.- - - - - - - - - - ranking = 1.875keywords = meningitis (Clic here for more details about this article) |
3/56. Spontaneous cerebrospinal fluid otorrhea from a tegmen defect: transmastoid repair with minicraniotomy.Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare condition that presents in 2 clinical categories. In congenital labyrinthine malformations, it leads to bouts of meningitis in a hearing-impaired child. In the adult age group, a spontaneous CSF leak almost always results from a dural and bony defect in the tegmen area. Possible pathogenic mechanisms include progressive sagging and rupture of dura through a congenital tegmen dehiscence and progressive bone erosion by aberrant arachnoid granulations. These patients usually present with a middle ear effusion, resulting in clear discharge after myringotomy with tube insertion. Based on 4 patients with a CSF leak from a tegmen defect, this report reviews the clinical findings and diagnostic approach. The surgical management by a 5-layer closure using a transmastoid approach with minicraniotomy is outlined. This procedure offers a relatively simple and reliable method for repair without the inherent risks of a middle fossa craniotomy.- - - - - - - - - - ranking = 0.125keywords = meningitis (Clic here for more details about this article) |
4/56. Neurotologic manifestations and treatment of multiple spontaneous tegmental defects.OBJECTIVE: To describe the causes, histopathologic features, manifestations, and treatment of symptomatic multiple spontaneous tegmental defects. STUDY DESIGN: Retrospective review of three clinical cases and one temporal bone histopathology report. CLINICAL FEATURES: Varied, including spontaneous cerebrospinal fluid otorhinorrhea, conductive hearing loss, chronic headaches, pneumocephalus, extradural abscess, and meningitis. A notable common feature was multiple (8-15) tegmental defects, 1 to 6 millimeters in diameter. Three of the four cases also included associated dural defects and small meningoencephaloceles or arachnoid granulations. Imaging studies generally underestimated the number of defects. INTERVENTION AND OUTCOMES: Successful middle cranial fossa repair with temporalis fascia was accomplished in the three clinical cases. Extension of exposure anteriorly and medially was necessary. Closure of the defects with a bone graft or equivalent synthetic material was not always possible, given the anatomic and pathologic features. Our data suggest that there are both congenital and acquired causes of the tegmental dehiscences. CONCLUSIONS: Multiple tegmen defects constitute a special entity. Successful repair requires a middle fossa craniotomy with extended exposure.- - - - - - - - - - ranking = 0.125keywords = meningitis (Clic here for more details about this article) |
5/56. cerebrospinal fluid otorrhea through a congenitally patent fallopian canal.Cerebrospinal fluid (CSF) otorrhea is a relatively rare entity that may occur either as a spontaneous occurrence or as a result of trauma or surgery. Spontaneous CSF leaks may be found during tympanocentesis, myringotomy, or tube insertion for chronic middle ear effusion. Rapid identification of the problem and timely treatment are required to avoid life-threatening complications such as meningitis. The site of leakage must also be identified so that the disorder can be treated effectively. Computed tomography, magnetic resonance imaging, and radionucleotide localization scanning all play a role in the early identification of the leakage site. A detailed knowledge of possible CSF leakage pathways aids in evaluating imaging studies. We report 2 rare cases of CSF otorrhea through a congenitally patent facial canal and their management.- - - - - - - - - - ranking = 0.125keywords = meningitis (Clic here for more details about this article) |
6/56. acinetobacter meningitis following head trauma.A case of acinetobacter meningitis following head injury in a patient who developed cerebrospinal fluid otorrhea, and did not have any neurosurgical procedure, is presented. Previously reported cases are cited, with a review of the literature. pefloxacin monotherapy is associated with a poor clinical response.- - - - - - - - - - ranking = 0.625keywords = meningitis (Clic here for more details about this article) |
7/56. Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients.Isolated cases of spontaneous cerebrospinal fluid (CSF) leakage with and without middle ear encephalocele have been reported. These leaks are usually accompanied by episodes of recurrent meningitis, hearing loss, or chronic headache. In this article, we report seven new cases of spontaneous CSF leakage. Six of these patients had conductive hearing loss and serous otitis media, and three had recurrent meningitis. Prior to a definitive diagnosis, six patients had received myringotomy tubes, which produced profuse clear otorrhea. Three patients had positive beta-2 transferrin assays. Computed tomography and magnetic resonance imaging confirmed a defect in the temporal bone tegmen. A combined transmastoid and middle fossa surgical approach with a three-layer closure was used to repair the tegmen defect. All patients had a lumbar drain placed prior to surgery. In addition to describing the seven new cases, we review the history of CSF leakage and discuss diagnostic methods, surgical findings, and our recommendations for management.- - - - - - - - - - ranking = 0.25keywords = meningitis (Clic here for more details about this article) |
8/56. Subtotal petrosectomy in the treatment of cerebrospinal fluid fistulae of the lateral skull base.Cerebrospinal fluid (CSF) fistulae almost invariably lead to meningitis, even in the absence of other clinically obvious sequelae of the fistula such as a CSF fluid leak. The only effective means of reducing the risk of meningitis is surgical closure of the fistula. If surgery is to be recommended to patients with CSF fistulae even if they are currently asymptomatic, the morbidity of the procedure must be a principal determinant of the chosen technique. Recovery after the extracranial approach to a CSF fistula is much more rapid than after an intracranial procedure. The extracranial route is also free of the long-term risk of epilepsy which accompanies a craniotomy. The principal disadvantage of the lateral extracranial approach, failure of treatment, has been largely eliminated following studies into the obliteration of simple bony cavities using free adipose grafts. This paper describes our use of the extracranial approach to closure of CSF fistulae of the lateral skull base.- - - - - - - - - - ranking = 0.25keywords = meningitis (Clic here for more details about this article) |
9/56. Spontaneous cerebrospinal fluid otorrhea. Congenital anomaly of bony labyrinth a possible cause.A patient had recurrent meningitis as a result of a congenital anomaly of the bony labyrinth. As far as could be traced in the literature, this was the first time that an isolated congenital anomaly of the bony labyrinth could be shown to be the origin of spontaneous cerebrospinal fluid otorrhea and the resulting recurrent meningitis. In cerebrospinal fluid otorrhea of unknown origin, tomographic x-ray examination of the bony labyrinth is of utmost importance. For the detection of the finer details is the bony structure of the labyrinth, this tomography should be done according to one of the multidirectional techniques.- - - - - - - - - - ranking = 0.25keywords = meningitis (Clic here for more details about this article) |
10/56. Spontaneous cerebrospinal fluid otorrhoea: case report and literature review.Cerebrospinal fluid otorrhoea may occur through the temporal bone both in children and adults. In children it is generally associated with labyrinthine malformations and usually presents with hearing loss in a child with recurrent meningitis. In adults it is sequel to direct head injury, otologic or neurotologic surgery or infection. More rarely this pathology is described as being "spontaneous", occurring without any history of trauma, surgery or infection. Spontaneous cerebrospinal fluid otorrhoea in adults may present with dull symptoms such as a blocked ear or short term conductive hearing-loss. The anatomic site of this fistula is the tegmen tympani which may have a microscopic or macroscopic bone deficiency or sometimes even a "silent" meningoencephalic herniation. The authors describe a case of spontaneous cerebrospinal fluid otorrhoea occurring in an adult patient with bilateral absence of the tegmen tympani and review the literature regarding this specific. They suggest that its actual occurrence may be underestimated. Special attention should be given to adult patients with recurrent or persistent middle ear effusion. Any suspicion should be followed by meticulous imaging and surgical exploration since this may be a lifethreatnening situation.- - - - - - - - - - ranking = 0.125keywords = meningitis (Clic here for more details about this article) |
| | Next -> |