[From barotrauma otitis to a fulminant meningitis]

To report the case of a patient who in the follow-up of a barotrauma otitis presented a fulminant meningitis.

38 year old man sportsman who presented a barotrauma otitis during scuba diving. In spite of a treatment associating steroids and nasal vasoconstrictor this otitis persisted. Five weeks after the initial episode the patient went back to the clinics in emergency complaining of intense cephalgia for a few hours with impression of faintness without fever. The state of consciousness of the patient then degraded quickly during the conversation. Into the 15 minutes time, the patient slipped of a stuporous state to coma. Hospitalized in emergency in intensive care unit, the diagnosis of an otogenic meningitis with Streptococcus pneumoniae was made. The patient cured without sequelae.

An inadequate treatment accompanied by a favorable anatomical factor facilitated the diffusion of the bacterial invasive process of the ear drum through the osseous barrier until the dura mater. A banal barotrauma otitis which persists can cause serious complications. An antibiotic must be prescripted starting from stage III, i.e. when there is retrotympanic effusion. In front of a behavioral problem during an otitis, it is necessary to always think of the intracranial complications and not to delay the anti-infectious treatment which must be started as soon as possible. To obtain a complete cure without sequelae, it seems that the adapted anti-infectious treatment must be instaured within a time below 10 hours.