Arnold W, Bredberg G, Gstöttner W, Helms J, Hildmann H, Kiratzidis T, Müller J, Ramsden R T, Roland P, Walterspiel J N
Department of Otorhinolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
ORL J Otorhinolaryngol Relat Spec. 2002 Nov-Dec;64(6):382-9. doi: 10.1159/000067579.
Pneumococcal otogenic meningitis is a rare postsurgical complication that can develop following stapedectomy or after cochlear implantation. The bacterial infection can be fatal in some instances. A recent increase in the incidence of otogenic meningitis among cochlear implant wearers is of concern. The majority of meningitis cases are associated with a 2-component electrode manufactured by one cochlear implant company. The device with the added 'positioner' component has been withdrawn from the market (FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater Risk for Meningitis, Updated: August 29, 2002, www.fda.gov/cdrh/safety/cochlear.html). Not all cases have been subsequent to otitis media and symptoms have developed from less than 24 h up to a few years after implantation. The purpose of this paper is to review and discuss the pathogenesis, pathology/bacteriology and to elaborate on some clinical features of otogenic meningitis in implanted children and adults. Essential aspects of surgery, electrode design, and cochleostomy seal are discussed. Conclusions are drawn from the available data and recommendations are made for good practice in cochlear implantation and follow-up.
肺炎球菌性耳源性脑膜炎是一种罕见的术后并发症，可在镫骨切除术或人工耳蜗植入术后发生。在某些情况下，这种细菌感染可能是致命的。人工耳蜗佩戴者中耳源性脑膜炎发病率最近有所上升，令人担忧。大多数脑膜炎病例与一家人工耳蜗公司生产的双组件电极有关。带有附加“定位器”组件的该装置已从市场上撤回（美国食品药品监督管理局公共卫生网络通知：人工耳蜗接受者患脑膜炎的风险可能更高，更新时间：2002年8月29日，网址：www.fda.gov/cdrh/safety/cochlear.html）。并非所有病例都继发于中耳炎，症状在植入后不到24小时至数年不等的时间内出现。本文旨在回顾和讨论其发病机制、病理/细菌学，并详细阐述植入儿童和成人耳源性脑膜炎的一些临床特征。还将讨论手术、电极设计和蜗窗密封的关键方面。根据现有数据得出结论，并对人工耳蜗植入及随访的良好实践提出建议。
