[Therapy of otogenic and rhinogenic meningitis]

There is no clear statement in literature on the problem of indication for surgery in cases of otogenic or rhinogenic meningitis. It is the aim of the present study to determine if and under what conditions conservative therapy alone is efficient and when surgery is absolutely indicated. The cases of 115 patients with endocranial complications, who were treated at our clinic over a period of 22 years, were evaluated; their number per year is significantly continually decreasing. The patients were subdivided into four groups: 1. otogenic/operated, 2. otogenic/non-operated, 3. rhinogenic/operated, 4. rhinogenic/non-operated. The individual groups were then compared in respect of 8 different parameters. The main cause of the disease in Group 1 was the chronic inflammation, in Groups 2 and 3 the acute inflammation and in Group 4 the new trauma. The status localis, the state of consciousness and the number of liquor cells were the most important parameters for establishing the diagnosis "meningitis", while the rigidity of the neck, the body temperature and the x-ray film yielded less reliable findings. On the basis of the results of our study we come to the conclusion that cause and progress of meningitis are decisive factors for the indication for surgery. We consider that immediate surgery (with high doses of antibiotics) is necessary in unconscious patients and in chronic inflammations as the cause of the meningitis. In all other cases treatment should be effected consisting of high doses of antibiotics, with thorough observation of the patients, and the patient should be operated on only if the disease aggravates or fails to improve within the first few days.