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Otorinolaringologia 2018 September;68(3):96-100

DOI: 10.23736/S0392-6621.18.02149-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Preliminary study on the surgical management of otogenic meningitis in the ICU

Fulvio L. MAMMARELLA 1, Melissa ZELLI 1, Claudio M. PIANURA 1, Gianluca BELLOCCHI 1, Theodoros VARAKLIOTIS 1 , Alberto EIBENSTEIN 2, Luisa MARCHIONI 3, Giulia V. STAZI 3

1 Department of Ear, Nose, and Throat, San Camillo Forlanini Hospital, Rome, Italy; 2 Department of Applied Clinical Sciences and Biotechnology (DISCAB), University of L’Aquila, L’Aquila, Italy; 3 Intensive Care Unit, Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy


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BACKGROUND: Meningitis is the most common intracranical complication in course of middle ear infection. There is an international agreement for the antibiotic therapy but not in the surgical option (myringotomy vs. mastoidectomy) or in timing (early vs. late).
METHODS: A retrospective analysis was performed in 27 subjects with otogenic meningitis. The patients were divided in three groups (no surgery, early surgery, and late surgery), and three parameters were considered: the mortality rate, the number of days in intensive care, and assisted ventilation.
RESULTS: Six patients were not subjected to surgical therapy for the presence of an instable cardiopulmonary frame. The remaining 21 patients were subjected to miringotomy associated or not with mastoidectomy. The comparison of hospitalization days and mechanical ventilation between the two groups which underwent in surgical therapy showed a better outcome in early-group approach.
CONCLUSIONS: Otogenic meningitis remains a life-threatening disease (none of the three groups has zero mortality rate) however surgical early procedure is always advisable (and applicable in all cases in a mini-invasive way) to reduce the length of presence in the ICU without affecting the mortality rate.


KEY WORDS: Bacterial meningitis - Intensive care units - Critical care

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