Department of E.N.T, A.I.I.M.S. (All India Institute of Medical Sciences), Bhubaneswar, India.
Department of E.N.T, A.I.I.M.S. (All India Institute of Medical Sciences), Bhubaneswar, India.
Int J Pediatr Otorhinolaryngol. 2022 Aug;159:111215. doi: 10.1016/j.ijporl.2022.111215. Epub 2022 Jun 28.
To review the efficacy of endoscopic management with or without cochlear implantation in a pediatric population presenting with recurrent meningitis due to inner ear incomplete partition type 1 (IP-1).
A multicentric report of 6 patients with a history of recurrent meningitis due to IP-1 was done. Radiological evaluation was performed to confirm the diagnosis. Transcanal endoscopic repair of the defect was performed in 3 cases, 2 cases underwent endoscope-assisted repair followed by cochlear implantation in the contralateral ear later, and 1 patient underwent endoscopic repair along with simultaneous cochlear implantation.
Radiology confirmed the diagnosis and identified the site of the leak. A leak was detected in all cases from the stapes footplate. Two patients with unilateral deformity had a CSF-filled cyst protruding through a defect in the stapes footplate, and the rest of the four had a high flow CSF leak from the footplate. Five patients who underwent repair have had no further episodes of meningitis. One patient who received simultaneous implantation and repair developed postoperative meningitis managed successfully with antibiotics.
Hearing loss due to inner ear deformity can be easily missed as a cause for recurrent meningitis, especially if unilateral. A high index of suspicion, audiological screening and radiology are essential to clinch the diagnosis. In such cases, a pure endoscopic or endoscopic assisted transcanal approach to repair CSF otorrhoea is an effective alternative to more radical procedures like subtotal petrosectomy with obliteration. In patients with bilateral profound hearing loss, simultaneous cochlear implantation and repair of the defect can be performed successfully.
回顾内镜治疗伴或不伴耳蜗植入术治疗因内耳不完全分隔 I 型（IP-1）导致复发性脑膜炎的儿科患者的疗效。
对 6 例因 IP-1 导致复发性脑膜炎的患者进行了多中心报告。进行了放射学评估以确认诊断。在 3 例病例中进行了经耳道内镜修复，2 例在对侧耳进行内镜辅助修复后随后进行了耳蜗植入，1 例进行了内镜修复并同时进行了耳蜗植入。
放射学证实了诊断并确定了漏口的位置。所有病例均从镫骨足板检测到漏口。2 例单侧畸形患者有充满 CSF 的囊肿通过镫骨足板的缺陷突出，其余 4 例有高流量 CSF 从足板漏出。接受修复的 5 例患者均未再发生脑膜炎。1 例同时接受植入和修复的患者术后发生脑膜炎，经抗生素治疗成功。
内耳畸形引起的听力损失很容易被忽视为复发性脑膜炎的原因，尤其是单侧。高怀疑指数、听力筛查和放射学对于明确诊断至关重要。在这种情况下，经耳道内镜或内镜辅助的经耳道途径修复 CSF 耳漏是比更激进的手术（如部分岩骨切除术伴闭塞）更有效的替代方法。对于双侧深度听力损失的患者，可以成功地同时进行耳蜗植入和修复。
