Author(s)
Isaac D. Erbele, MD
Gauri Mankekar, MD
Rahul Mehta, MD
Jacob B. Kahane, MD
Terry P. Murphy, MD
Samuel R. Barber, MD
Moisés A. Arriaga, MD
Affiliation(s)
San Antonio Uniformed Services Health Education Consortium, San Antonio, TX; Louisiana State University Health, Shreveport, LA; Louisiana State University Health, New Orleans, LA; University of New Mexico, Albuquerque, NM
Abstract:
Objective: Propose bony tegmen defects in the setting of otitis media as a cause of otogenic meningitis
Study Design: Case series
Setting: Tertiary care
Patients: Fifteen sequential cases of bacterial meningitis with otitis media in 14 adult patients without prior surgeries to the involved ear, between 2017 and 2023
Interventions: CT temporal bone, surgical repair
Main Outcome Measures: CT findings, surgical findings, clinical course
Results: All 15 cases of bacterial meningitis with otitis media had tegmen defects on CT temporal bone (average age=63, standard deviation=14). Defects were surgically confirmed with middle cranial fossa repair in 14, each performed after their meningitis was successfully treated with intravenous antibiotics. One patient declined surgery. Ten cases had three or more tegmen defects. One case had a cerebral spinal fluid (CSF) leak and four had encephalic herniation. None had cholesteatoma or idiopathic intracranial hypertension. In one case, the tegmen defect was identified prior to the episode of meningitis.
Conclusions: In these sequential cases of otogenic meningitis, each had one or more defects of the tegmen. While circumstantial and requiring additional study, this series provides compelling support for the theory that exposing purulent middle ear secretions to bare, intact dura may be a substantial cause of otogenic meningitis, even in the absence of CSF fistula or encephalic herniation. We believe the simultaneous occurrence of (1) otitis media with (2) osseous tegmen defects to be a sufficient two-hit mechanism for otogenic meningitis.
Professional Practice Gap & Educational Need: Understanding causes of otogenic meningitis
Learning Objective: Identify the association between tegmen defects and osteogenic meningitis
Desired Result: Propose bony tegmen defects in the setting of otitis media as a significant cause for otogenic meningitis
Level of Evidence - Level IV
Indicate IRB or IACUC : LSU IRB#581?