Otogenic meningitis

1. By – Sanjay Ekka (110)

2. Definition
• Inflammation of leptomeninges (pia and
arachnoid) usually with bacterial invasion of csf
in subarachnoid space
• Most common intracranial complication
• Follow Acute Otitis media (AOM)in children and
infants
• And chronic suppurative Otitis media (csom) in
adults.

3. Mode of Infection
• Blood borne – most common in Infants and
children
• Bone erosion
• Retrograde thrombophelbitis

4. ON EXAMINATION
- Neck rigidity
- kernig sign positive
- Brudzinski's sign positive
- Tendon reflexs
exaggerated intially but later
becom sluggish or absent

5. • Symptom and signs of meningitis are due to
▫ 1 . Presence of infection
▫ 2. Raised ICP
▫ 3.Meningeal and cerebral irritation
1. Fever (102-104 ) with chills and rigor
2. Headache
3. Neck Rigidity
4. Photophobia and mental irritability
5. Nausea and Vomiting
6. Drowsiness - may progress to delirium or coma
7. Cranial Nerve Palsies and Hemiplegia

6. Diagnosis
• CT or MRI
• Lumber Puncture
• CSF examination
▫ Turbid , Cell count
▫ Predominant polymorphs
▫ Raised protein
▫ Reduced sugar
▫ Culture and sensitivity

7. Treatment
• Medical
▫ Antimicrobial Therapy against causative organism
▫ Corticosteroids and antibiotics combination helps
reduce neurological or audiological complications
• Surgical
▫ Meningistis after AOM
 Myringotomy or cortical mastoidectomy
▫ Meningitis after CSOM with Cholesteatoma
 Radical or modified radical mastoidectomy