Meningitis Following Otologic Surgeries: A Review

Abstract

Objective

The review aimed to examine the incidence, etiology, and time course of meningitis as a postoperative sequela of otologic surgeries.

Data Sources

PubMed, Cochrane, and Web of Science databases.

Review Methods

The date range was 1960-2022. MESH terms “meningitis”, “postoperative complications”, and subcategories of otologic surgical procedures identified through PubMed’s MESH terms “auditory brain stem implantation”, “cochlear implantation”, “endolymphatic shunt”, “labyrinth fenestration”, “mastoidectomy”, “middle ear ventilation”, “myringoplasty”, “ossicular replacement”, “stapes surgery”, and “tympanoplasty” were used with “AND”. Additional studies were identified from reference lists. Non-English and non-human studies were excluded. Studies were included if they specified the presence/absence of meningitis irrespective of the primary goal of the study and provided the number of patients.

Results

140 studies were reviewed for a total of 57,108 patients. 49.0% were male, and 57.5% were pediatric patients. There were 215 patients with meningitis, most commonly following cochlear implantation at 72.1% of the total cases. Inner ear malformations were noted in 38.3% of patients with meningitis. Streptococcus pneumoniae was the most common causative agent, followed by Pseudomonas aeruginosa, aseptic, and Haemophilus influenzae. The timing of meningitis ranged from 0-180 months post-otologic surgery. Vaccination status was reported in 14.3 to 34.7% of studies. The overall incidence of meningitis following otologic surgeries was 0.38%, from 1951-1999 was 0.35%, and from 2000-2020 was 0.39%.

Conclusion

Meningitis post-otologic surgery continues to have an impact on pediatric and adult patients. Meningitis can occur immediately or after many years following otologic surgery, necessitating continual vigilance. S. pneumoniae is the leading causative agent for postoperative meningitis. Inner ear malformations increase susceptibility to postoperative meningitis. While pre- and post-operative vaccinations likely have had an impact on decreasing the number of reported cases, the rates of meningitis remained generally stable with minor increases over time.