Issue N# 3 - 2010
From barotrauma otitis to a fulminant meningitis
Authors : Vo-Tan D, Portmann D, Carrat X. (Ho Chi Minh, Bordeaux)
Ref. : Rev Laryngol Otol Rhinol. 2010;131,3:229-232.
Article published in french
Downloadable PDF document french
Objectives: To report the case of a patient who in the follow-up of a barotrauma otitis presented a fulminant meningitis. Clinical case: 38 year old man sportsman who presented a barotrauma otitis during scuba diving. In spite of a treatment associating steroids and nasal vasoconstrictor this otitis persisted. Five weeks after the initial episode the patient went back to the clinics in emergency complaining of intense cephalgia for a few hours with impression of faintness without fever. The state of consciousness of the patient then degraded quickly during the conversation. Into the 15 minutes time, the patient slipped of a stuporous state to coma. Hospitalized in emergency in intensive care unit, the diagnosis of an otogenic meningitis with Streptococcus pneumoniae was made. The patient cured without sequelae. Conclusion: An inadequate treatment accompanied by a favorable anatomical factor facilitated the diffusion of the bacterial invasive process of the ear drum through the osseous barrier until the dura mater. A banal barotrauma otitis which persists can cause serious complications. An antibiotic must be prescripted starting from stage III, i.e. when there is retrotympanic effusion. In front of a behavioral problem during an otitis, it is necessary to always think of the intracranial complications and not to delay the anti-infectious treatment which must be started as soon as possible. To obtain a complete cure without sequelae, it seems that the adapted anti-infectious treatment must be instaured within a time below 10 hours.
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