致死的髄膜炎を反復した小児内耳奇形への手術治療

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  • A Case of Recurrent Meningitis Caused by an Inner Ear Anomaly and an Obliteration Operation
  • チシテキ ズイマクエン オ ハンプク シタ ショウニ ナイジ キケイ エ ノ シュジュツ チリョウ

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In our institution, we came across a 4-year-old boy suffering from recurrent meningitis due to an inner ear anomaly and it proved very difficult to stop CSF (cerebrospinal fluid) leakage from the abnormal ear with ear surgery. The boy had been treated twice for meningitis by a pediatrician. He had a drug allergy for many kinds of antibiotics and so his hospitalization was long. He was congenitally deaf but no other developmental problem was seen.<br>The patient was referred to us, as clinical otologists, to identify the original lesion causing the meningitis to evaluate his deafness. High resolution computed tomography (CT) showed ballooning enlargement of the right inner ear and a deficiency of the left inner ear. Auditory brainstem response and distortion product of otoacoustic emission were missing. An operation to stop the CSF leakage from the ear with the anomaly was performed with soft tissue obliteration, but a large volume of CSF gushed out from his right external ear canal. Reoperation was necessary four days after the initial surgery with a hard material, namely cortical bone.<br>The presence of inner ear anomalies may increase CSF pressure and produce leakage, followed by meningitis. CT of the inner ear is very important to identify the fistula from which CSF is leaking. The closure operation is necessary immediately and reoperation is sometimes necessary soon after the first surgery. A hard obliterating material, such as cartilage or bone, seemed to be better to block the severe leak completely rather than a soft material, such as a fascia graft.

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