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Published on: March 5, 2022
Novel repair of stapedial footplate defect associated with recurrent meningitis
Shinji Urata1, Akinori Kashio, Takashi Sakamoto
1*Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; and †Department of Otolaryngology, JR Tokyo General Hospital, Tokyo, Japan.
Insights
A novel partial obliteration technique using an incus graft effectively treated recurrent meningitis caused by stapedial footplate defects. This method preserves the inner ear for potential cochlear implantation and avoids vestibular injury.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Surgery
Background:
- Recurrent meningitis linked to stapedial footplate defects often requires complete inner ear obliteration.
- This radical approach can compromise future auditory and vestibular function.
Observation:
- Two pediatric patients with congenital inner ear malformations presented with recurrent meningitis.
- High-resolution computed tomography (HRCT) identified cerebrospinal fluid (CSF) leakages from stapes footplate fistulae.
Findings:
- A partial obliteration technique using a shaped incus graft and temporalis fascia successfully sealed the fistulae.
- No recurrence of CSF leakage or meningitis was observed post-surgery.
- Patients reported no post-operative vertigo or dizziness.
Implications:
- This technique offers a less invasive alternative to complete inner ear obliteration.
- Preservation of the inner ear space facilitates potential cochlear implantation.
- Minimizing vestibular injury improves patient outcomes and quality of life.
Objective:
Recurrent meningitis resulting from a partial defect of the stapedial footplate is most frequently treated by complete obliteration of the inner ear. Herein, we report the use of a partial obliteration technique in which the fistula is plugged with a shaped incus.
Patients:
A 5-year-old girl and a 7-year-old boy who had congenital inner ear malformations both developed recurrent meningitis. High-resolution computed tomography (HRCT) revealed soft tissue opacities between the mastoid air cells and the mesotympanum. Exploratory tympanotomies were performed, revealing cerebrospinal fluid (CSF) leakages from fistulae at the stapes footplate in both patients.
Interventions:
In each case, the vestibule was partially obliterated with temporalis fascia and modified incus remnant. Bone dust and fibrin were also applied.
Main Outcome Measures:
Recurrence of CSF leakage and patient symptoms.
Results:
None of the patients exhibited vertigo or dizziness after surgery, and meningitis did not recur during the follow-up period.
Conclusions:
Compete obliteration of the inner ear space can be avoided by using this technique, thereby leaving room for future cochlear implantation in addition to reducing direct injury to the vestibular system.
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