Acute Bacterial Meningitis Caused By Acute Otitis Media in Adults (Revisited)

Purpose: To characterize and report the outcome of a homogenous series of adults with acute bacterial meningitis caused by acute otitis media (ABMAO).
Design and Setting: A retrospective chart review of medical files of patients admitted and treated for ABMAO in our tertiary medical center from 1994 to 2017.
Main outcome measures: Characteristics and clinical course of patients.
Results: Sixteen patients with ABMAO were identified, with a mean age of 51 years. Eleven patients were males and were5 females. Fever was the most common sign, observed in 12 out of 16 patients, followed by otalgia, headache and confusion. An opaque and bulging tympanic membrane was observed in eleven out of the sixteen patients.
Cultures of CSF ear and blood were positive for Streptococcus Pneumonia, in the CSF, ear and blood in 8, 6 and 4 of the patients respectively and one patient had positive ear culture of Moraxella Catarrhalis. Immediate treatment included tympanocyntesis, with aspirates sent for bacteriological cultures. Nine out of the sixteen patients underwent surgery. Six patients were operated early - during the disease process and three were operated at a later stage. Two patient who were operated at a later stage suffered from recurrent ABMAO. An Intraoperative bony defect of the tegmen, with exposed arachnoid tissue was demonstrated in both patients. A cortical mastoidectomy was performed in all operated patient, except for one, who underwent canal wall down mastoidectomy In two patients with the defect in the tegmen, it was repaired. Fourteen patients achieved full recovery. One patient died (6.25 %), and one had a poor neurological outcome. Both were older than 60 years.
Conclusion: Early diagnosis and administration of antibiotics with myringotomy are crucial for control of disease. Surgery consisting of cortical mastoidectomy with ventilation tube insertion can be reserved for cases with lack as well as for the repair of a presumed anatomical defect.