Otogenic intracranial complications

Q: Which of the following is the most common cause of otitic meningitis? (select one)

A) S. pneumoniae

B) H. influenzae

C) Group A streptococcus

D) Neisseriae meningitidis 

Answer: A

The objective of the above question is to emphasize that otitic meningitis is the most common intracranial complication of chronic otitis and mastoiditis. It can occur in acute otitis media too but is relatively uncommon in acute episodes. History is the most vital aspect, as clinical signs and lumbar puncture (LP) findings are as universal as to any other cause of meningitis.

The most common organism is S. pneumoniae, followed by H. influenzae. These both should always be covered. Local antibiogram should be consulted to avoid resistance as delay in antibiotic may be harmful. Moreover, neurosurgical services should be alerted in case of non-resolving symptoms.

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References:

1. Kaplan DM, Gluck O, Kraus M, et al. Acute bacterial meningitis caused by acute otitis media in adults: A series of 12 patients. Ear Nose Throat J 2017; 96:20.

2. Migirov L, Duvdevani S, Kronenberg J. Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol 2005; 125:819.