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Otology/Neurotology

(308) Meningitis Following Otologic Surgeries

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Quan Lu, BA

    Medical Student
    Northeast Ohio Medical University
    Rootstown, Ohio, United States

    • Senior Author(s)

  • Anita Jeyakumar, MD MS

    Director Otology and Cochlear Implant Programs
    Bon Secour Mercy Health St Elizabeth Boardman Hospital
    Akron, Ohio, United States

Disclosure(s):
Quan Lu, n/a: No relevant relationships to disclose.
Anita Jeyakumar, MD MS: No relevant relationships to disclose.


Introduction: Otogenic meningitis is a rare but possible complication of otologic surgery, given the proximity of the middle and inner ear structures, vessels, and brain. The review aimed to examine the prevalence and etiology of meningitis as a postoperative complication of otologic surgeries.

Methods: IRB approval was obtained. The date range for the review was 1960-2022. The review was performed using PubMed, Cochrane, and Web of Science databases with MESH terms “meningitis”, “postoperative complications”, “auditory brain stem implantation” (ABI), “cochlear implantation” (CI), “endolymphatic shunt”, “labyrinth fenestration”, “mastoidectomy”, “middle ear ventilation”, “myringoplasty”, “ossicular replacement”, “stapes surgery”, and “tympanoplasty”. Additional studies were identified from reference lists. Non-English and non-human studies were excluded using automatic filters. Studies were included if they specified the presence or absence of meningitis as a post-op complication.

Results: A total of 92,674 patients were reviewed. 48.9% were male, and 55.3% were pediatric patients (age < 18 years). Postoperative meningitis was observed most commonly following CI, more commonly in pediatric patients (93.2%). Inner ear malformations were noted in 43.8% of pediatric CI with meningitis. The most commonly found pathogen was S. pneumoniae, followed by P. aeruginosa. Timing of postop meningitis ranged from 0 days to 8 years for CI, 0 days to 6 years for stapes surgery, 10 days to 6 years for ABI, and 1 day to 21 years for mastoidectomy. Vaccination status was provided inconsistently across studies. Based on reported data, the incidence rate of meningitis in otologic surgeries from 1958-1999 was 0.0035, and from 2000-2020 was 0.0033.

Conclusions: Meningitis post-otologic surgery continues to have an impact on pediatric and adult patients. Inner ear malformations increase susceptibility to postoperative complications. While vaccinations likely have had an impact on the decrease in rates of meningitis, the data is complex. Soft surgical techniques and technological advances may have improved the rate of meningitis.