Recurrent meningitis in children due to inner ear abnormalities

Abstract

Recurrent meningitis in children is not only a potentially life threatening condition, but often involves the child in the trauma of repeated hospital admissions and multiple and invasive investigations to try and find an underlying cause. Symptoms and signs of CSF rhinorrhoea or otorrhoea are infrequent in these patients. Unilateral deafness may be difficult to diagnose in the young child. Full ENT examination may be normal.We report seven cases of children with recurrent meningitis in whom inner ear abnormalities were only indicated as the site of entry of infection by hypocycloidal tomography or high resolution CT scanning of the temporal bone. Subsequent tympanotomy confirmed the site of the CSF leak as the oval window in the majority of cases; packing the vestibule with muscle halted further attacks in these patients.

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

“…Plain skull X-rays are rarely helpful in this setting, and highresolution computer tomography (CT) scanning of the temporal bones is considered to be the method of choice to confirm the diagnosis by most authors (133,164,165,171).…”

Spontaneous cerebrospinal fluid otorrhoea via oval window: an obscure cause of recurrent meningitis

“…Imaging of these patients usually reveals severe labyrinthine deformity, particularly, cystic deformity of the cochlea and vestibule. 5 Leakage of the CSF commonly occurs through the oval window. Thirteen out of 15 cases in Parisier and Birken's review and five out of seven cases in the review of Quiney et al had leaks via the oval window.…”

Recurrent acute otitis media associated meningitis in a patient with a contralateral cochlear implant and bilateral cochleovestibular dysplasia

“…Numerous reports have documented CSF fistulas in children with recurrent meningitis and inner ear malformations [3][4][5][6]. More attention has been given to this association in the last year as an increased incidence of meningitis has been suggested in cochlear implant recipients.…”