ORIGINAL ARTICLE   

Otorhinolaryngology 2022 June;72(2):55-8

DOI: 10.23736/S2724-6302.22.02413-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of tympanotomy and mastoidectomy in the management of otogenic meningitis

Fulvio MAMMARELLA ¹, Antonella LOPERFIDO ¹ ✉, Claudio M. PIANURA ¹, Giulia V. STAZI ², Luisa MARCHIONI ², Gianluca BELLOCCHI ¹

¹ Unit of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy; ² Intensive Care Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy

BACKGROUND: Otogenic meningitis (OgM) is a life-threatening complication of middle ear infections such as acute otitis media and chronic suppurative otitis media with or without cholesteatoma. This clinical condition requires a multidisciplinary approach among different medical specializations. There is univocal international agreement in the administration of medical antibiotic treatment, whereas the role of surgery is still unclear and there are no specific guidelines. Aim of our paper was to report the role of surgical procedures, in particular tympanotomy and mastoidectomy in the management of OgM.
METHODS: We were able to identify 21 cases of OgM coming to our observation from Lazzaro Spallanzani National Institute for Infectious Diseases IRCCS, Rome, Italy, from January 2010 to December 2015, and treated both by antibiotic and surgical approach. Afterwards we performed an additional record search looking for OgM cases managed in the previous period 2008-2009, before the start of our joint protocol, treated exclusively by antibiotics (9 cases).
RESULTS: Twenty-seven surgical procedures were performed, 8 were exploratory tympanotomies with tube insertion and 19 were mastoidectomies. None of the 21 patients died due to OgM. Noticeably we found a dramatic drop from 22% to 0% in terms of death rate comparing the results of our group with the group treated only by antibiotics. In addition, we were able to conclude that interval between hospitalization and surgery has a clinical prognostic role (10 days the cut-off).
CONCLUSIONS: Our results show that surgery is recommended in addition to antibiotics, it should be performed as soon as possible, and the type of surgical technique should be chosen based on features of each clinical case.

KEY WORDS: Otolaryngology; Meningitis; Otitis media; Mastoidectomy; Otologic surgical procedures