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Published on: January 9, 2019
Cochlear implantation after deafness from Pasteurella multocida meningitis
Jeffrey Dewitt Warner1, Ashwini Milind Tilak2, Sudhir Manickavel2
1Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA jdwarner@uab.edu.
Abstract:
A woman in her late 40s who works as a veterinary technician represented to the emergency department with increasing headache, confusion, neck stiffness, subjective fevers and distorted hearing 2 days after diagnosis of viral infection at an outside emergency department.Diagnosis of Pasteurella multocida was made from blood cultures and lumbar puncture. Intravenous ceftriaxone was administered for 21 days. By the time of resolution of acute meningitis, she had become completely deaf bilaterally. MRI revealed faint early ossification/possible labyrinthitis ossificans of the basal cochlea, which was confirmed on surgical exploration during the placement of cochlear implants bilaterally 42 days later. We discuss how the atypical features of this infection lead to diagnostic delay and high morbidity, the unique imaging/surgical findings resulting from the infection, and the clinical utility of early and bilateral cochlear implantation in this and similar cases.
Insights
A veterinary technician developed severe meningitis due to Pasteurella multocida, leading to bilateral deafness. Early cochlear implantation was crucial for hearing restoration in this rare case.
Area of Science:
- Infectious Diseases
- Neurology
- Otolaryngology
Background:
- A veterinary technician presented with symptoms mimicking viral illness, including headache, confusion, and neck stiffness.
- Delayed diagnosis of bacterial meningitis caused by Pasteurella multocida occurred due to atypical initial presentation.
Observation:
- The patient developed bilateral profound hearing loss during treatment for meningitis.
- Magnetic Resonance Imaging (MRI) revealed early labyrinthitis ossificans in the basal cochlea.
Findings:
- Pasteurella multocida meningitis can lead to severe cochlear complications and hearing loss.
- Surgical exploration confirmed ossification, necessitating bilateral cochlear implants.
Implications:
- This case highlights the importance of considering bacterial meningitis in patients with neurological symptoms, even after a viral diagnosis.
- Early bilateral cochlear implantation is vital for managing hearing loss resulting from meningitis-induced labyrinthitis ossificans.
