Critical Care | Family Medicine | Higher Education | Medicine and Health Sciences | Neurology | Otolaryngology
Introduction: Cerumen impaction is a common problem seen in primary care clinics. There are a variety of methods to deal with impacted cerumen including water irrigation but meningitis after water irrigation cerumen removal has not been previously reported.
Methods: We describe the case of a 59-year-old female with otitis media who developed meningitis with empyema after water-jet irrigation for impacted cerumen.
Results: Our patient presented 24-hours after water-jet irrigation for impacted cerumen with worsening headaches. Workup included positive CSF cultures and empyema on MRI consistent with meningitis. She also had ear drainage from the treated ear which was positive for multiple organisms. Neurologically she deteriorated in the short term but began to improve with intensive intravenous treatment. She was treated with six months of intravenous antibiotics and transitioned to further treatment with oral antibiotics as her laboratory testing and imaging improved. She showed ultimate resolution of labs, imaging and neurologic findings, returning to baseline.
Conclusion: We report the first case to our knowledge of meningitis after water-jet irrigation for impacted cerumen. We recommend care when treating impacted cerumen in patients with underlying otitis media as there may be a risk for meningitis in certain circumstances.
Cerumen impaction, meningitis, cerumen removal
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Tenny, S., Lookian, P., Wakim, A., , Surdell, D. Irrigation for cerumen removal causing meningitis – case report. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1).