[Congenital fistula of the stapedial footplate as an avenue for recurrent purulent meningitis].
BACKGROUND
Congenital fistula of the stapedial footplate is a rare cause of recurrent purulent meningitis and a diagnostic and therapeutic problem as well.


METHODS
We report a case of a stapedial fistula diagnosed intraoperatively in a 4-year-old boy, after recurrent meningitis. The boy was hospitalized at the Pediatric Clinic three times in a 6-month period because of recurrent meningitis. The applied anti-meningitis therapy presented with good general state of the child, but the main target was to discover the cause of recurrent meningitis. Immunologic and genetic investigations were performed. Otorhinolaryngologic findings nearly normal, except minimal asymmetry in the otoscopic finding. Eardrum was reddish with all other characteristics of a normal drum. The tympanometric curve was of type B/C on the right ear. MRI revealed hydrocephalus internus with signs of inflammation of mastoid cells and cavum tympani indicating explorative myringotomy and antrotomy. Intraoperatively, we found cerebrospinal fluid in the antrotympanic cavity, including malformation of the incus without contact with stapes and fistula on the middle part of the stapedial footplate with flow out of the perilymph.


CONCLUSIONS
Perilymphatic fistula is a rare cause of recurrent meningitis, whereas congenital ear malformation may be a cause of recurrent meningitis, particularly in children. The diagnosis is intraoperative. The surgical treatment may be very difficult, often requiring revision of procedures especially if cerebrospinal fluid pressure is increased.
Vlaski
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L
Klinika za bolesti uva, grla i nosa, Klinicki centar, Novi Sad.
Milosević
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D
Dankuc
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D
Komazec
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Z
D002675:Child, Preschool; D005402:Fistula / Q000150:complications / Q000151:congenital*; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000209:etiology*; D012008:Recurrence; D013199:Stapes / Q000002:abnormalities*
Kongenitalna fistula stapedijusne ploce kao put rekurentnog purulentnog meningitisa.