髄膜炎を契機に診断し得た成人の内耳奇形例

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  • A Case of Adult Inner Ear Malformation Who Presented with Meningitis
  • ズイマクエン オ ケイキ ニ シンダン シエタ セイジン ノ ナイジ キケイレイ

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<p>Inner ear malformations are among predisposing factors for recurrent meningitis. Adult cases are, however, rare, as most cases are treated in early childhood. A 47-year-old woman with a history of recurrent bacterial meningitis visited our hospital complaining of fever, ear pain, and watery rhinorrhea. Her past medical history was significant in that she had congenital hearing loss in the right ear. Examination revealed a pulsatile eardrum and colorless effusion. An audiogram showed complete deafness in the right ear. CT of the temporal bone revealed the cystic cochleovestibular malformation and absence of the modiolus. T2-weighted images of head MRI showed high-intensity fluid in the tympanic cavity and mastoid cavity. We diagnosed cerebrospinal fluid (CSF) leakage due to incomplete partition type I, which is one of the inner ear malformations, and performed surgery. Leakage was observed from the fistula of the stapes footplate, and CSF gushed out when the stapes was removed. This CSF gusher was repaired by multiple layer packing of the vestibule with adipose tissue, bone putty, and cartilage plate. The postoperative course was uneventful. There has been no recurrence of CSF leakage or meningitis until now, 4 years since the surgery.</p><p>In the case of meningitis with deafness, it is important to carefully search for inner ear malformations and CSF leakage using CT and MRI. Multiple layer packing was useful in this case as a surgical procedure for recurrent meningitis.</p>

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