Recurrent meningitis in the pediatric patient - the Otolaryngologist's role

Objective: To assess the etiology of recurrent meningitis in the pediatric patient. Design. Retrospective case series and literature review. Setting: Tertiary-care pediatric hospital. Patients: Children (<17-years-old) with r ecurrent meningitis, treated at Texas Children's Hospital (TCH) between 198 4 and 1995. Results: A review of 463 cases of bacterial meningitis over an 11 year period revealed six children aged 3 months to 15 years with the dia gnosis of recurrent meningitis. The patient's age, number of episodes of me ningitis, diagnostic investigations performed and etiologies of recurrent m eningitis were recorded. Fifteen episodes of meningitis were identified in these six patients; Streptococcus pneumoniae represented the bacteriology i n 73% of the cases. Two patients were diagnosed with temporal bone abnormal ities, two children with immunological deficiencies and no underlying etiol ogy for the recurrent meningitis was identified in the remaining two patien ts. In this series, one-third of patients had an otolaryngologic etiology f or their recurrent meningitis. These six patients, along with a review of t he recent literature, will highlight the need for otolaryngological assessm ent and the importance of considering immunological investigations when man aging recurrent meningitis in the pediatric patient. Conclusion: We propose that children with recurrent meningitis of unknown etiology undergo: (1) a n audiological evaluation; (2) a CT scan of the temporal bones, skull base and paranasal sinuses; and (3) an immunological evaluation. (C) 1999 Publis hed by Elsevier Science Ireland Ltd. All rights reserved.