Recurrent Meningitis due to a Congenital Fistula in the Stapedial Footplate

Abstract

\s=b\A patient with recurrent meningitis had spontaneous CSF leakage from the fistula of the stapedial footplate. The patient was a 7-year-old boy with profuse CSF otorrhea, proved by myringotomy. A roentgenographic examinatioin and computed tomography scan of the temporal bone demonstrated an abnormal bony labyrinth. During the operation, a leak was found at the fistula of the stapedial footplate. Surgical obliteration of the fistula with temporal muscle and fascia has prevented the recurrence of meningitis. (Arch Otolaryngol 1983;109:697-700) Cerebrospi nal fluid otorrhea can be caused by skull fracture, surgi¬ cal trauma, inflammation (ie, otitis media associated with cholesteato¬ ma), tumor, or congenital malforma¬ tion.1 Cases of spontaneous CSF otor¬ rhea are very rarely seen. In the present study, a patient with episodes of recurrent meningitis who had an abnormality of the stapes and the inner ear is described.A 7-year-old boy was first seen at the Hiroshima University Hospital on July 2, 1981, at which time he was in good health and had no abnormality in his extremities and trunk. He was born after a full-term healthy pregnancy, during which his moth¬ er took no medication. His development, both mentally and physically, had been commensurate with his age. There was no history of head trauma or family history of hearing loss. His first bout of pneumococcal meningitis developed at the age of 16 months, in June 1975, and he subsequently suffered from five more recurrences in a five-year period. , with acute men¬ ingitis and treated with ampicillin and made an uneventful recovery at each attack of meningitis at another hospital. The organism cultured from the CSF on each bout was found to be a pneumococcus.There was no acute otitis media preceding each meningitis. At the time of the last recurrence, the patient's mother noticed that he had a clear liquid running from the right nostril and that he complained of an earache in his right ear. The patient was not aware of any tinnitus or vertigo at any time. Pentetate indium disodium In 111 cisternography demonstrated a CSF leak from the region of the face. He was there¬ fore transferred to our clinic under suspi¬ cion of a case of CSF rhinorrhea.Examination of the ears revealed that the right tympanic membrane was opaque without discoloration or bulging. The left ear was normal. An audiogram showed complete sensorineural hearing loss on the right and a type C tympanogram was recorded in the same ear (Fig 1). No nys¬ tagmus was observed and the caloric stim¬ ulation showed no response on the right side, while the left ear showed a normal response. The nose and throat were normal but, on bending the head forward, the slow steady stream was running from the right nostril and a sugar reduction test of the fluid was positive.The roentgenogram of the sinuses was normal, but the roentgenogram of the tem¬ poral bone (Schüller's view) showed wellpneumatized mastoid air cells bilaterally and an increase in density on the right side (Fig 2). In Stenvers projection, the ...

Spontaneous cerebrospinal fluid otorrhoea via oval window: an obscure cause of recurrent meningitis

“…The CSF leakage through the oval window could be due to an associated faulty development of the stapes, such as a hole in the footplate, or due to an increase in the vestibular perilymph pressure which displaces the footplate, leading to defects in the annulus. 6,8 The latter was the case in our patient.…”

“…1,2,5,6 Potential sites of cerebrospinal leak in the inner ear include the oval window, stapes footplate, eustachian tube and promontory fistula. [5][6][7][8][9][10] The leaks are mostly due to congenital temporal bone dysplasia with fistulous connections between the subarachnoid space and the middle ear cavity.…”

Meningoencephalocele of the temporal bone: Pictorial essay on transmastoid extradural-intracranial repair

“…Congenital defects present with a bony dehiscence, often of the tegmen, that gradually widens with constant pulsations of the overlying arachnoid and weight of the temporal lobe. Congenital defects may include enlarged petrosal fallopian canal, patent tympanomeningeal fissure (Hyrtl's fissure), stapedial footplate fistula, and Mondini dysplasia (underdeveloped cochlea and vestibule) [20][21][22]. Idiopathic intracranial hypertension (typically in obese, middle-aged women) is also associated with temporal spontaneous CSF leaks [1,[23][24][25].…”

Bilateral oval window fistulae with recurrent meningitis

“…There have now been fourteen cases reported of such defects in the stapes footplate (Barr and Wersall, 1965;Bennett, 1966;Crook, 1967;Rice and Waggoner, 1967;Stool et al, 1967;Gundersen and Haye, 1970;Schultz and Stool, 1970;Biggers et al, 1973;Parisier and Birken, 1976;Richards and Gibbin, 1977;Nakano and Ito, 1977;Saito et al, 1979;Hirakawa et al, 1983), and these cases have varied considerably. The age of the patient at the first episode of meningitis varies from three months to thirteen years.…”