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Recurrent meningitis in children due to inner ear abnormalities
R E Quiney1, D B Mitchell, B Djazeri
1E.N.T. Department, Royal Sussex County Hospital, Brighton.
Insights
Recurrent meningitis in children can stem from inner ear abnormalities. Surgical repair of cerebrospinal fluid (CSF) leaks at the oval window successfully prevented further meningitis attacks in young patients.
Area of Science:
- Neurology
- Otolaryngology
- Pediatrics
Background:
- Recurrent meningitis in children presents diagnostic challenges.
- Cerebrospinal fluid (CSF) leaks are often occult, with infrequent signs like rhinorrhea or otorrhoea.
- Inner ear abnormalities are rarely identified as the source of recurrent meningitis.
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.