CSF otorrhoea

CSF otorrhoea

The discharge of CSF from the ear, a rare, potentially life-threatening situation that requires rapid intervention to prevent meningitis linked to an abnormal communication between the sterile subarachnoid space with the sinonasal tract flora.

Aetiology
Post-operative complication of skull-base surgery—e.g., for acoustic neuroma, or far less commonly, for cholesteatoma—where 6 to 12% of skull-base procedures have some form of CSF leakage. CSF otorrhea occurs in 21% of cases of temporal bone fractures. Spontaneous CSF otorrhoea is almost a “case report” rarity.

Clinical findings
Clear fluid leakage from ear, nose, strange salty taste in back of throat, unilateral hearing loss, which may be sensorineural, suggesting other inner ear defects (e.g., Mondini deformity), or conductive, suggesting a leak elsewhere in the temporal bone.

Diagnosis
High-resolution CT with axial and coronal planes; bright spinal fluid signal in middle ear on T2 sequences and partially empty sella on MRI.

Management
Antibiotics, with the caveat that this is not universally advised, given that prophylactic antibiotics may select for treatment-resistant bugs and frustrate treatment in the event of actual meningitis. Surgery is in the form of plugs of fascia, gelfoam, fat or muscle, with obliteration of mastoid and mastoidectomy for “uncooperative” cases.