Temporal Bone Skull Base Defects - The Value and Importance of Early Based Detection to Prevent Late Costly Morbidity and Mortality

Objective: The purpose of this value-based retrospective study was to compare 20 patients with acute bacterial otogenic meningitis to patients with spontaneous cerebrospinal fluid leaks (sCSF) from idiopathic intracranial hypertension (IIHT), assessing demographics including age, sex, body mass index (BMI) and radiographic features. Materials and Method: This study is a retrospective chart and radiographic review, with focus on value-based care, of 20 patients with acute bacterial otogenic meningitis over five years from January 2014 to January 2019, at tertiary hospitals Perth, Western Australia, compared to recently published cohort of 90 patients with sCSF (49). Mann-Whitney U Test was used to compare the differences between the two groups, an alpha value of 0.05 was considered statistically significant. Patients were compared with respect to age, sex, body mass index, clinical exam and radiological investigations. Results: Patients with otogenic meningitis had similar characteristics to sCSF and IIHT, characterised by middle to older age and elevated BMI and non-traumatic skull base temporal bone defects. At risk patients may require ENT assessment and dedicated skull base and temporal bone imaging to exclude skull base or tegmen defects. Conclusions: Retrospective review of 20 acute bacterial meningitic patients, revealed demographics similar to sCSF, including elevated BMI and mid to slightly older age. Value- based care in patients with fluid in middle ear and mastoid is enhanced by ENT evaluation and dedicated skull base and temporal bone imaging to evaluate for bony dehiscence that may necessitate treatment to prevent otogenic meningitis with associated morbidity and mortality.