LXIV Some Observations on Temporal Bone Sections and Otitic Meningitis
L. C. Boemer
Sep 1, 1933
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4
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Journal
Annals of Otology, Rhinology & Laryngology
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Key Takeaway Key Takeaway: The mastoid cavity and dura have a direct communication with the epidural abscess, suggesting that otitic meningitis may be a direct result of mastoid dysfunction.
Abstract
Literature abounds in excellent contributions relative to meningitis of otitic origin. Histologic reports proving the origin and pathway of the infection are comparatively rare. One finding, substantiating macroscopic observation made heretofore, was noted in a study of the horizontal serial sections of a right temporal bone in a case of pneumococcus type III meningitis. The patient, white, female, age 7, entered with classic signs and symptoms of meningitis. The present illness began seventeen days previously with pain in and around the right ear, which subsided under treatment without incision of the drumhead. A year previously there was a discharge of moderate duration from the same ear. Examination showed the ear drums intact, not injected, and landmarks present. The right drum, however, was dull and slightly thickened. Impending respiratory failure contraindicated surgical intervention. Fig. 1 (No. 4280), Sec. 230, represents photomicrographic proof of the otogenic origin of the meningitis. Examination of the cranial cavity failed to establish this fact. There is shown not only a direct anatomic connection between the mastoid cavity and the dura via the subarcuate fossa, but also a direct communication between the infected parantral cells and an epidural abscess. Courvillerefers to this appropriately as follows: "A developmental process which is still in progress during infancy and childhood is the gradual obliteration of the fossa subarcuata, During this period an opening, situated above and