Cerebrospinal fluid otorrhea and pseudomonal meningitis in a child with Mondini dysplasia: case report

Management of Meningitis Due to Cystic Cochleovestibular Malformation: a Stitch in Time

Spontaneous CSF otorrhea alludes to those cases which have no known etiology like traumatic, iatrogenic, neoplastic or infectious. The presentation of the patient depends on the anatomical integrity of the eustachian tube as well as the tympanic membrane. Children with certain congenital inner ear malformations, including incomplete partition deformity, show a higher incidence of spontaneous CSF leaks and the resultant meningitis. Cystic vestibulocochlear deformity accounts for approximately 20% of inner ear malformations. In this case report, we discuss a child who presented with first episode of meningitis and with the help of thorough clinical otorhinolaryngological examination and radiology, was diagnosed with a congenital ear anomaly. With this paper, we stress upon the importance of keeping an open mind regarding the differential diagnosis of any condition, and the value of timely intervention.

Pseudomonas aeruginosa meningitis following head injury after cochlear implantation: A case report

Bacterial meningitis is a rare event in children with cochlear implants. A 7-year-old child who underwent cochlear implantation (CI) for the right ear 6 years ago was admitted to our hospital with the chief complaint of intermittent fever and headache for 6 months. Cochlear implant infection was suspected. The right cochlear implant removal and middle ear exploration were performed. Postoperatively, the bacterial cultures of cerebrospinal fluid (CSF), cochlear implant and inserting electrodes all suggested Pseudomonas aeruginosa. The body temperature of the child was controlled within 2 weeks after the operation by using meropenem, and other symptoms like headache and abdominal pain disappeared. During 20-month follow-up visit, the child did not suffer any discomforts. In conclusion, we reported a child who developed Pseudomonas aeruginosa meningitis following head injury after CI. This case should serve as a reminder for clinical doctors.

Diagnosis and management of pediatric cerebrospinal fluid leakage secondary to inner ear malformations: A report of 13 cases

OBJECTIVES

Inner ear malformations (IEM) with cerebrospinal fluid (CSF) leakage in children is a rare condition, nevertheless, it may lead to meningitis. Early diagnosis and treatment are crucial. The aims of the study were to summarize the clinical characteristic of pediatric CSF leakage secondary to IEM, and to recommend transcanal endoscopic ear surgery (TEES) as an effective surgical technique for the treatment of CSF leakage with IEM in children.

METHODS

This was a retrospective study. Thirteen children and fourteen ear surgery were included. Demographics, detail history, laboratory data, Audio test, and imageological examination results were recorded. All the pediatric patients underwent TEES.

RESULTS

Most (92.31%) of the children presented with a history of rhinorrhea. 69.23% (9/13) of the children had suffered from meningitis, and the other had presented with respiratory tract infections. The follow-up duration ranged from 0.75 years to 5.29 years. Transcanal endoscopic repair of CSF leakage secondary to IEM was the first surgery with a success rate of 92.86% (13 out of 14 cases). A fistula could be found in the stapes footplate in all pediatric patients.

CONCLUSION

Even if there has been no history of meningitis, the diagnosis of CSF leakage in children suffering from unilateral rhinorrhea and recurrent respiratory tract infection is considered. Auditory brainstem response (ABR) and Temporal bone computed tomography (CT) examinations are suggested to identify IEM. The TEES procedure is recommended in our study as the first choice that repairs CSF leakage secondary to IEM.

Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations

OBJECTIVE

The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations.

STUDY DESIGN AND SETTING

We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology.

PATIENTS

We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear.

INTERVENTION(S)

Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days.

MAIN OUTCOME MEASURE(S)

We did evaluate our technics with the recurrence of CSF leak.

RESULTS

Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases.

CONCLUSIONS

Our "minimally invasive" technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.

Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases

OBJECTIVE

To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia.

METHODS

A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented.

RESULTS

The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair.

CONCLUSIONS

CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament.

Familial nonsyndromic hearing loss with incomplete partition type II caused by novel DSPP gene mutations

BACKGROUND

Familial nonsyndromic hearing loss (NSHL) with incomplete partition type II (IP-II) is a very rare condition.

AIMS/OBJECTIVES

To determine the audiological feature, inheritance patterns and genetic etiology of familial NSHL with IP-II in a Chinese family with eight family members.

MATERIAL AND METHODS

Clinical data were collected from all eight family members, selected deafness genes were sequenced in proband and whole genome sequencing of seven family members was performed.

RESULTS

The proband were a pair of male nonidentical twins (III:1, III:2). Three patients in this family, including the twins and their father (II:1), were diagnosed with bilateral NSHL with IP-II, and no mutation was found in the genes of SLC26A4, GJB2, GJB3, mitochondrial 12S rRNA, and MITF. Whole genome sequencing data indicated de novo mutations of the gene DSPP, c.3085A > G and c.3087C > T, which resulted in p.N1029D and co-segregated with deafness phenotype, were the underlying genetic etiology.

CONCLUSION AND SIGNIFICANCE

Familial NSHL with IP-II is extremely rare. In this family, de novo DSPP gene mutations, were considered to be the most probable genetic etiology. And this is the first report to reveal DSPP gene mutations leading to familial NSHL with IP-II.