The term "otogenic meningitis" refers to an acute inflammatory process that affects the lining of the brain. This is an extremely dangerous condition, accompanied by the formation of purulent contents and increased intracranial pressure. Otogenic meningitis can develop in people of any gender and age. The main cause of the pathology is inflammation localized in the ear. In the absence of timely treatment, the risk of developing serious complications increases.
Causes
The disease is a negative consequence of chronic or acute otitis media. In most cases, the causative agents of purulent meningitis are staphylococci, pneumococci and streptococci. As a rule, pathology develops against a background of chronic otitis media. The acute form of the disease most often leads to inflammation of the meninges in children, due to the anatomical features of their body.
The process of development of pathology can be labyrinthogenic and tympagenic. In the first case, the causative agent of the disease (meningitis) penetrates from the inner ear into the subarachnoid space. It is customary to talk about the tympagenic process in the case when the penetration of the infection to the membranes of the brain occurs through natural openings that are designed for blood vessels. In addition, against the background of the inflammatory process, bone destruction can begin. The consequence of this is the formation of new holes, which serve as additional entry gates for infection.
There are 2 types of otogenic meningitis:
- Primary. It is characterized by the transition of the inflammatory process immediately to the meninges. Infection occurs by contact or hematogenous route.
- Secondary. Otogenic meningitis in this case is a consequence of other complications. These include: an abscess of brain tissue, sinus thrombosis.
In young children, meningism is isolated. This is a pathological condition characterized by irritation of the meninges, which occurs against the background of diseases of the middle ear. At the same time, the child has direct connections between the hearing organ and the cranial cavity (for example, non-closure of the gap between the scales of the temporal bone and the pyramid).
In the International Classification of Diseases (ICD-10), otogenic meningitis is assigned the code G00.
Features of the pathology
Depending on the speed of development, the ailment can be:
- Lightning fast. It is characterized by the appearance of severe symptoms in the first few days or even hours after involvement of the meninges in the pathological process.
- Sharp. In this case, the development of otogenic meningitis occurs almost asymptomatically against the background of existing otitis media.
- Chronic. As a rule, the disease is a consequence of an acute process in the absence of adequate treatment of the latter.
- Recurrent. Short periods of remission are replaced by exacerbations.
- Atypical. This form of the disease is characterized by an erased symptomatology.
In order to prevent the transition of the disease to a severe form, it is necessary to consult a doctor when the first alarming signs appear.
Symptoms
In the clinical picture of otogenic purulent meningitis, it is customary to distinguish between general manifestations of infectious pathology, meningeal, brain and focal.
In almost all cases, the disease begins with an increase in body temperature to high values. Since otogenic purulent meningitis is a consequence of otitis media, an increase in temperature most often originates from subfebrile indicators. Body temperature is constant, its fluctuations are small and amount to no more than 1 ° C. Less commonly, the onset of the development of pathology is less acute in which subfebrile or even normal temperature indicators are maintained.
Common manifestations of infectious pathology also include:
- Changes in the work of the cardiovascular system. The degree of their intensity directly depends on the severity of the intoxication process. As a rule, patients have tachycardia.
- Rapid, but rhythmic breathing.
- Dry tongue. Plaque can be detected on it.
- Pallor of the skin.
- Severe general condition of the patient. Only in 3% of cases the patient's well-being can be characterized as satisfactory.
Meningeal symptoms include:
- Headache. This symptom often accompanies otitis media. In this regard, it is necessary to pay attention to a change in the nature of painful sensations. With otitis media, it is localized in the behind the ear, temporal and occipital zones. A symptom of otogenic meningitis is a diffuse headache. It is intense and bursts from the inside. In some cases, it radiates to the spine and neck.
- Nausea. A similar sign is detected in 90% of cases. A third of patients experience vomiting that is not related to eating. As a rule, it occurs with increased severity of headache. This should be remembered so as not to take vomiting for a sign of poisoning.
- Stiff neck. It is one of the main meningeal symptoms. It manifests itself already in the first day, in the following days its severity becomes brighter. If you try to bend the person’s head forward, you can detect tension in the back muscles of the neck. A patient alone cannot reach her chest with her chin. At the same time, head tilting is noted. When you try to make any movement with it, a sharp pain occurs.
- Symptom Kernig. A person in a relaxed position should lie on his back. It is necessary to take his leg and bend it at a right angle. Against the background of irritation and tension of the nerve roots, the limb is very difficult to straighten back in the knee joint.
- The upper symptom of Brudzinsky. With a sharp bending of the head, a reflex pulling of the lower extremities to the stomach occurs. If you bend your arms at the elbow joints, shoulders rise.
- The lower symptom of Brudzinsky. If the patient’s relaxed leg is bent, the other also reflexively changes its position.
- Zygomatic symptom of ankylosing spondylitis. Not always manifested unambiguously. Its essence is as follows: if you gently beat with a special hammer along the zygomatic arch, a sharp increase in headache occurs.
Brain symptoms:
- Lethargy.
- Inhibition.
- Short stiffness (one of the forms of impaired consciousness).
- Stunned.
- Psycho-emotional instability.
- Delirious state. A rare and severe symptom of otogenic meningitis. If available, the use of psychotropic drugs is indicated. Its duration is 2-3 days, with further complete amnesia of what happened in a given period of time.
The presence of focal symptoms requires differential diagnosis of otogenic meningitis from brain abscess. These signs include: minor changes in the fundus, changes in the composition of the blood and cerebrospinal fluid.
Diagnostics
Meningitis is a disease whose outcome directly depends on the timeliness of contacting a specialist. In case of deterioration of well-being (especially against the background of acute or chronic otitis media), it is necessary to call an ambulance team or arrive at a medical institution on your own.
With otogenic meningitis, the results of the following studies should be reflected in the patient's medical history:
- Blood analysis. In the presence of pathology, the leukocyte formula shifts to the left. The rate of ESR also increases sharply. In all cases, neutrophilic leukocytosis is noted.
- Analysis of cerebrospinal fluid is the main diagnostic method for meningitis. It is possible to confirm suspicions about the presence of the disease already at the stage of the external examination of biological material. Even with mild turbidity, it is customary to talk about pleocytosis. This is a condition in which the level of cellular elements in the cerebrospinal fluid rises. With purulent otogenic meningitis, their concentration may exceed 600 * 106 / l. An informative indicator is the level of leukocytes. If neutrophilic blood cells prevail, this indicates the progression of the pathology. With an increase in the number of eosinophils and lymphocytes, it is customary to talk about the stabilization of the process. In addition, with otogenic meningitis, the cerebrospinal fluid pressure and protein level increase, and chlorides and sugar decrease.
- CT and MRI.
It is important to conduct differential diagnosis. Otogenic meningitis (unlike cerebrospinal epidemic) develops in most cases slowly. Gradually, meningeal symptoms begin to appear, over time, their intensity increases. Moreover, the general condition of the patient does not always correspond to the severity of the inflammatory process.
In children, against the background of purulent otitis media, a fulminant form of the disease sometimes develops. In such cases, differential diagnosis is carried out with tuberculous, serous viral and cerebrospinal epidemic meningitis.
Surgical treatment
In the presence of even the slightest suspicion of a patient's pathology, they are hospitalized in a hospital. First of all, in the treatment of purulent otogenic meningitis, surgical debridement of the lesion is performed. Elimination is the main event. It is carried out regardless of the severity of the patient's condition and changes occurring in the ear.
There are no contraindications to the operation. Surgical treatment of otogenic purulent meningitis is carried out even with a very serious condition of the patient. This is due to the fact that the remaining focus of pathology is a constant source of pathogens that continuously penetrate into the subshell space. This increases the severity of the intoxication process.
In addition, in most cases, otogenic meningitis is not the only complication arising from otitis media. In some cases, pathology is combined with sinus thrombosis and abscesses. The presence of such complications is detected, as a rule, only in the process of surgical intervention. An ENT examination reveals only minor changes, which in most cases do not correspond to the actual degree of destruction. The true picture is most often revealed during surgical events.
With otogenic meningitis, an extended sanitizing operation of the ear is performed. In addition to the standard volume of intervention, the hard shell of the brain is exposed in the area of the roof of the sigmoid sinus and mastoid process. If there is a suspicion of an abscess of the posterior cranial fossa, the doctor gains access to the medial wall of the antrum.
Drug therapy
At the same time as surgery, otogenic meningitis is treated with drugs.
The therapeutic regimen includes the following items:
- Reception of antibacterial agents.
- Dehydration.
- Detoxification.
- Reception or administration of drugs designed to reduce the degree of permeability of the blood-brain barrier.
- Symptomatic Therapy
Medicines are prescribed exclusively by a doctor, he also determines the effective dosage and method of application. It is most advisable to carry out antibiotic treatment at the initial stage of the development of pathology. This is because the effectiveness of the drugs in this case is higher, since the formation of purulent foci has not yet been completed, and they are easier to treat.
As a rule, doctors prescribe Penicillin. Intramuscularly, the drug is administered every 3 hours, dividing the daily dose into equal parts. The maximum concentration of the active component in the cerebrospinal fluid is achieved in the first 4 hours. In severe cases and in the presence of a relapsing form of the disease, in which the patient's condition did not improve for several days, the drug is infused intravenously.
It is allowed to administer medications based on penicillin sodium salt through endolumbar puncture. However, frequent intervention in the cerebrospinal space provokes the development of negative changes in it. In this regard, the endolumbar administration of the drug is advisable only if the patient's condition is extremely serious or if he has a fulminant form of otogenic meningitis. Currently, simultaneously with Penicillin, other antibacterial agents are prescribed, for example, Linkomycin or medicines of the cephalosporin group.
Pathogenetic therapy involves the following measures: reducing the permeability of the blood-brain barrier, detoxification and dehydration. The duration of treatment depends on the general condition of the patient.
The standard scheme involves the administration of drugs based on mannitol, intravenous infusion of "Lasix", injection of "Magnesium sulfate" intramuscularly and oral administration of "Glycerin". For the purpose of detoxification, a heavy drink is prescribed. Also shown is the intake or administration of B vitamins, ascorbic acid, glucose. In order to reduce the degree of permeability of the blood-brain barrier, intravenous administration of "Urotropin" is prescribed.
Symptomatic therapy is indicated. If the general condition of the patient is worsened, tonic medications, cardiac glucosides and analeptics are prescribed.
Forecast and possible complications
In order to prevent the development of negative consequences, it is necessary to consult a doctor in a timely manner. Some complications of otogenic form meningitis pose a threat not only to health, but also to the patient's life. In this regard, self-medication is unacceptable. In the best case, the clinical picture will be smeared, which will make the diagnosis difficult, in the worst case, death will occur.
The main complications of otogenic meningitis are:
- Frequent bouts of headache.
- Cerebrosthenic syndrome.
- Reduced attention span.
- Increased fatigue.
- Psycho-emotional instability (tearfulness, moodiness, irritability).
- Increased motor activity.
- Fussiness.
- Lethargy.
- Dementia.
- Inhibition of reactions.
- Visual impairment.
A dangerous complication of the disease is cerebral edema. Against the background of the development of this pathological process, compression of vital centers occurs. Acute edema occurs 2-3 days after the onset of the disease, with fulminant meningitis - after only a few hours.
With timely treatment, the prognosis is in most cases favorable. According to statistics, about 15% of cases of otogenic meningitis are fatal.
After recovery, asthenia, hearing loss, and some focal signs of mild severity are most often found in patients. The severe consequences can also include deafness, epilepsy, hydrocephalus, dementia and amaurosis. But it is worth noting that at present they are diagnosed extremely rarely.
First aid
If there are warning signs, an ambulance team must be called in. It is not recommended to take antipyretics and other medicines on your own. Before the arrival of specialists, it is necessary to ensure patient peace.
Absolutely all patients with suspected meningitis are hospitalized in the infectious diseases department. If the patient's condition is extremely serious or he is in a coma, he is placed in the intensive care unit. Admission to the neurological department is also acceptable.
After that, doctors urgently examine the patient and take biomaterial (blood and cerebrospinal fluid). Based on the research results, the most effective treatment regimen is compiled. According to indications, resuscitation measures are carried out.
Prevention
Otogenic meningitis is a consequence of acute or chronic otitis media. In the presence of this disease of the hearing organ, it is necessary to strictly follow the recommendations of the attending physician. Adequate and timely therapy reduces the risk of meningitis to a minimum.
A specific preventive measure is vaccination. It is necessary to be vaccinated against meningococcal and pneumococcal infections, mumps, rubella, measles and hemophilic bacillus. In addition, it is important to regularly carry out activities aimed at strengthening the body's defenses.
Finally
Otogenic meningitis is a purulent inflammation of the membranes of the brain. The disease is a complication of otitis media of acute or chronic nature. Pathology can occur in different ways. Also, the disease is characterized by a variety of clinical manifestations. In this regard, if alarming signs occur, you should consult a doctor.With a pronounced deterioration in well-being, it is recommended to call an ambulance team. The outcome of the disease directly depends on how timely treatment was started. In the best case, recovery occurs (but at the same time, the risk of negative consequences), and in the worst - death.