title: Otitic meningitis, superior semicircular canal dehiscence, and encephalocele:  a case series.
abstract: BACKGROUND
  Otitic meningitis in the postantibiotic era is still a serious condition, requiring intensive treatment and prolonged rehabilitation. In view of the significant morbidity and mortality rate, conditions that may increase the likelihood of otitic meningitis developing should be treated promptly. The incidence of meningitis after asymptomatic encephaloceles of the middle cranial fossa varies greatly, and the management differs between elective surgical repair and expectant careful observation. Superior semicircular canal dehiscences (SSCDs) are postulated to have a congenital origin and are associated with a thin or dehiscent tegmen. Several cases of simultaneous SCCD and tegmen defects have been reported, but the findings of otitic meningitis, SCCD, and encephaloceles has, to the best of our knowledge, not been previously explored in the literature.
  
  
  METHODS
  We reviewed a series of 4 patients who all presented with a combination of otitic meningitis, encephaloceles, and SSCD.
  
  
  RESULTS
  All the 4 patients we reviewed had meningitis secondary to otitis media with computed tomographic scans confirming the presence of SCCD with ipsilateral tegmen tympani defects and associated cephaloceles. All patients were treated with intravenous antibiotics and underwent surgery that ranged from myringotomy and ventilation tube insertions, mastoidectomy, and burr hole drainage for temporal lobe abscess. They were all associated with intensive care unit admission, significant morbidity, and prolonged hospital stays. There were no mortalities.
  
  
  CONCLUSIONS
  We propose that in all SSCD patients, a careful computed tomographic examination of the cranial base should be undertaken to exclude other associated tegmen tympani defects. In cases of SSCD requiring surgery, we support the view that elective surgical repair be recommended where asymptomatic ipsilateral encephaloceles are found, to reduce the risk of otitic meningitis.
authors.affiliation: Department Otolaryngology-Head Neck and Skull Base Surgery, Sir Charles Gairdner Hospital, Ear Science Centre, The University of Western Australia, Nedlands WA 6009, Australia. michaellim24@ymail.com
authors.forename: Zixiang Michael
authors.initials: ZM
authors.lastname: Lim
authors.forename: Peter Leon
authors.initials: PL
authors.lastname: Friedland
authors.forename: Rudolf
authors.initials: R
authors.lastname: Boeddinghaus
authors.forename: Andrew
authors.initials: A
authors.lastname: Thompson
authors.forename: Stephen John
authors.initials: SJ
authors.lastname: Rodrigues
authors.forename: Marcus
authors.initials: M
authors.lastname: Atlas
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004677:Encephalocele / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D010031:Otitis / Q000175:diagnosis / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects; D012665:Semicircular Canals / Q000473:pathology / Q000601:surgery*; D013529:Surgical Wound Dehiscence; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents