title: Acute bacterial meningitis caused by acute otitis media in adults: A series of 12 patients.
abstract: We conducted a retrospective chart review to characterize the outcomes of 12 patients-9 men and 3 women, aged 21 to 79 years (mean: 49)-who had been treated at our tertiary care center for acute bacterial meningitis caused by acute otitis media (ABMAO). Fever was the most common presenting sign/symptom, observed in 8 patients, followed by otalgia, neck stiffness, headache, and confusion. An opaque and bulging tympanic membrane was observed in 8 patients. Cultures were positive for Streptococcus pneumoniae in the cerebrospinal fluid, ear, and blood in 7, 5, and 3 patients, respectively. Immediate treatment included tympanocentesis, with aspirates sent for bacteriologic cultures. Seven patients (58.3%) underwent surgery; 5 were operated on early, and 2 underwent surgery at a later stage because of a suspected defect in the mastoid bone. A cortical mastoidectomy was performed in 6 of the 7 surgical patients; the remaining patient underwent a canal-wall-down procedure. Ten patients experienced a full recovery, 1 died, and 1 had a poor neurologic outcome (vegetative state); both of the latter 2 patients were older than 60 years. We conclude that early diagnosis, administration of antibiotics, and myringotomy are crucial for control of ABMAO. A cortical mastoidectomy with ventilation tube insertion can be reserved for patients who do not respond, which is common.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Soroka University Medical Center and Faculty of Health Sciences, Beer Sheva, Israel. dankap@bgu.ac.il.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kaplan
authors.forename: Ofer
authors.initials: O
authors.lastname: Gluck
authors.forename: Mordechai
authors.initials: M
authors.lastname: Kraus
authors.forename: Youval
authors.initials: Y
authors.lastname: Slovik
authors.forename: Hindy
authors.initials: H
authors.lastname: Juwad
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D046508:Culture Techniques; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000379:methods; D010033:Otitis Media / Q000150:complications* / Q000628:therapy; D013506:Otologic Surgical Procedures / Q000379:methods; D018458:Persistent Vegetative State; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000150:complications* / Q000628:therapy; D013296:Streptococcus pneumoniae; D000069356:Tympanocentesis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents