Novel repair of stapedial footplate defect associated with recurrent meningitis

Objective: Recurrent meningitis resulting from a partial defect of the stapedial footplate is most frequently treated by complete obliteration of the inner ear. Herein, we report the use of a partial obliteration technique in which the fistula is plugged with a shaped incus.

Patients: A 5-year-old girl and a 7-year-old boy who had congenital inner ear malformations both developed recurrent meningitis. High-resolution computed tomography (HRCT) revealed soft tissue opacities between the mastoid air cells and the mesotympanum. Exploratory tympanotomies were performed, revealing cerebrospinal fluid (CSF) leakages from fistulae at the stapes footplate in both patients.

Interventions: In each case, the vestibule was partially obliterated with temporalis fascia and modified incus remnant. Bone dust and fibrin were also applied.

Main Outcome Measures: Recurrence of CSF leakage and patient symptoms.

Results: None of the patients exhibited vertigo or dizziness after surgery, and meningitis did not recur during the follow-up period.

Conclusions: Compete obliteration of the inner ear space can be avoided by using this technique, thereby leaving room for future cochlear implantation in addition to reducing direct injury to the vestibular system.