Otologist's Perspective of Recurrent Meningitis

Abstract

Objectives: Congenital cerebrospinal fluid (CSF) leaks of the ear can be a potential cause of recurrent meningitis. Diagnosing the otogenic cause can be a challenge due to the spectrum of presentations. We aim at studying the various modes of presentation, radiology, and intraoperative findings of such CSF leaks. Methodology: This was a retrospective study of six patients of recurrent meningitis. Detailed history and clinical signs were noted. Audiometry was done. Computed tomography (CT) scan of the paranasal sinus and high-resolution CT of the temporal bone were done. CT cisternography was done for confirmation. Magnetic resonance brain was done in the immediate postmeningitic phase when CT cisternography is contraindicated. All the cases were explored surgically to identify and repair the site of the leak. Results: One had unilateral deafness and five had bilateral deafness. Two had incomplete partition (IP)-I deformity and four had IP-II. Surgical exploration revealed the leak site as only oval window in three patients and both round and oval windows in two. Conclusion: Otorhinology consultation is a must for all cases of recurrent meningitis. It is important to pick up subtle clinical signs for diagnosis. Multiple leak sites should be anticipated in such cases intra-operatively.