Inner Ear Malformation with Recurrent Meningitis

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We report a case of inner ear malformation with three episodes of bacterial meningitis. A 3-year-old girl suffered from recurrent meningitis. CT scanning revealed bilateral inner ear malformation (incomplete partition type). Profound hearing loss in both ears was found by audiometric examination, and fluid from the puncture of the right tympanic membrane contained glucose, resulting from cerebrospinal fluid (CSF) leakage. To prevent the recurrent meningitis, we tried a tympanoplasty to block the CSF leakage. Before the operation, intermittent spinal fluid drainage was performed to control of the CSF pressure. The bony foot plate of the stapes was defective and replaced the membranous plate there. There was no anomaly in other auditory ossicles. When the superstructure of the stapes was removed, a severe gusher of CSF occurred promptly, requiring extra-intermittent spinal drainage and an intravenous drip infusion of d-mannitol. We packed the fascia of the temporal muscle into the oval window tightly with the addition of adhesive fibrin glue. She has remained free from recurrent meningitis during 12 months follow-up since surgery.
Japan Society for Pediatric Otorhinolaryngologyの論文