Labyrinthitis Secondary to Meningococcic Meningitis: A Clinical and Histopathologic Study

Abstract

Deafness is, unfortunately, not an uncommon sequel of meningococcic meningitis. The deafness is usually bilateral and often complete. Not infrequently it is due to labyrinthitis secondary to an extension of infection from the meninges. The exact channel through which the infection is transmitted to the labyrinth cannot always be determined, nor is the pathologic picture in the early stages of the resultant labyrinthitis definitely known. It is assumed that this extension usually takes place either along preexisting routes, such as the nerve tunnels within the internal auditory meatus and the aquaeductus cochleae, or by way of the blood stream. This report is based on a study of serial sections of temporal bones which showed evidences of early as well as late pathologic changes in the labyrinth secondary to meningococcic meningitis.REPORT OF FOUR CASES OF EARLY CHANGES CASE 1.\p=m-\L.R., a boy aged 2 years, was admitted to the hospital on Jan. 22, 1929, with a history of malaise, fever, convulsions, a purpuric rash and meningeal signs. The duration of the illness was one day. Culture of the blood showed meningococci in all the mediums. The middle ears were normal. The child died on the day of admission. Postmortem examination revealed hemorrhages in the skin, conjunctiva, peritoneum and adrenal glands.Histologic examination of the temporal bone showed hemorrhages and purulent exudate in the internal auditory meatus ; hemorrhages within, and degeneration of, the organ of Corti, and hemorrhages in the stria vascularis and in the saccule. There was partial displacement of the membranous labyrinth in the semicircular canals. CASE 2.\p=m-\J.K., aged 19 months, was admitted to the hospital in a moribund state on March 22, 1929, with a history of fever, cyanosis, vomiting and purpuric rash for three days. Culture of the spinal fluid and of the blood showed meningococci. The middle ears were normal. The child died on the day of admission. Postmortem examination revealed acute purulent meningitis with meningococcemia, and petechiae of the skin, intestines and bladder.Histologic examination of the temporal bone showed purulent exudate with perivascular infiltrations about the main vessel in the internal auditory meatus, purulent From the Otologic Service and the laboratories of the Mount Sinai Hospital.

Chronology of labyrinthitis ossificans induced by streptococcus pneumoniae meningitis

“…The pathogenesis of new bone formation can be described as either metaplastic or osteoplastic 13 . In metaplastic osteogenesis the cell of origin is unestablished.…”

Immunohistochemical Analysis of Proliferating Cells in a Sterile Labyrinthitis Animal Model

“…Ibrahim and Linthicum 6 reviewed the various proposed mechanisms by which osteogenesis occurs within the cochlea. It was proposed that new bone may arise from the osteal lining cells of the labyrinth, 15,16 as a result of metaplasia of the connective tissue in the membranous labyrinth, 17 secondary to inflammatory stimulation from infection and the resulting fibrous matrix formation, 18 following exposure of bone marrow cells within the bony capsule, as a result of disruption of the endosteal lining, 19 or possibly induced by ischemia 20 …”

Nitrogen and Oxygen Molecules in Meningitis-Associated Labyrinthitis and Hearing Impairment

“…This is because tissue of the cochlea can only be obtained by autopsy. Therefore, most publications on the cochlear pathology in humans with bacterial meningitis are case reports or small series [23][24][25][26]. However, there is one study by Merchant et al [27] who investigated 41 cochleae of patients who died from acute bacterial meningitis.…”