PNEUMOCOCCAL MENINGITIS REVEALING A DYSPL ASIA OF THE BONY LABYRINTH IN AN INFANT

Background.-Dysplasias of the bony labyrinth are frequently associated with cerebrospinal fluid fistula and are usually discovered because o f recurrent meningitis. Case report.-A 1 year-old infant was admitted for a pneumococcal meningitis which appeared 2 days after the occurren ce of a clear otorrhea from the right ear. The same organism was isola ted from otorrhea fluid, which also contained cerebrospinal fluid as c onfirmed cytochemically. The meningitis rapidly resolved with antibiot ic treatment. Auditory brain stem responses were abolished form the ri ght ear. CT of the temporal bones showed a pseudo-Mondini type labyrin th dysplasia at the right ear and Mondini type dysplasia at the left o ne. A translabyrinthine cerebrospinal fluid fistula was discovered by surgical exploration of the right ear, occurring through a perforation in the stapedial foot plate. The leak was cured by packing the vestib ule and obturating both and round windows. Three years after the opera tion, the child did not experience any further episode of otorrhea of meningitis. Conclusions.-Features suggesting a translabyrinthine fistu la, especially otorrhea and deafness, should be systematically searche d in any child with bacterial meningitis. Closure of these fistulas ca n prevent severe infectious recurrences.