Otogenic meningitis: a five-year study.

IMPROVED treatment of acute and chronic otitis media has led to a significant reduction in the incidence of intracranial complications of otogenic origin. Modern surgical technique and the use of antibacterial agents have made these complications relatively rare and greatly improved their prognosis. Otogenic meningitis is still the most frequent complication (Nager, 1966), while cases of brain abscess, sinus thrombophlebitis, and extradural or subdural abscess are very rare. Courville (1955) reported that during the period 1928-33, one of 400 deaths was caused by intracranial complications due to ear infections, while these were the cause of only one of 4,000 deaths during the period 1949-54. This is a go per cent decrease in two decades. The survival rate of otogenic meningitis increased from 10-20 per cent to 50 per cent upon the introduction of sulphonamides (Proctor, 1966), and with penicillin the survival rate has increased to 80-85 P r c e n t (Nager, 1966; Proctor, 1966; Schuknecht and Montandon, 1970). Before the introduction of antibacterial chemotherapeutical agents, the incidence of intracranial complications was reported to be about 3 per cent of all patients with suppurative middle ear disease (Alford and Pratt, 1966), two-thirds of whom were chronic cases. Other papers report a predominance of acute otitis as j^sponsible for these complications in former time (Pang, 1967; Proctor, 1966), whereas chronic otitis is predominant today (Alford and Pratt, 1966; Nager, 1966; Proctor, 1966). The purpose of this paper is to present our experience in the treatment of patients with otogenic meningitis, together with a discussion of relevant 871