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.
References in periodicals archive ?
Any clear pulsating fluid through myringotomy should arise the suspicion of CSF otorrhoea and encephalocele.
All the investigations done, routine investigations are normal, CT scan of cisternography confirms CSF otorrhoea.
A small defect of 3mm size in the anterior aspect of tegmen tympani with contrast leak in to left middle ear cavity and mastoid air cells with opacification of cotton swab kept in left external ear--Findings are suggestive of CSF otorrhoea.
Diagnosis made as (L) CSF otorrhoea and posted for repair through transmastoid approach under general anaesthesia.
Congenital defects, infections and trauma can alter this structure in such a way that CSF otorrhoea results, (1) Intra-cranial surgery that extends through or into the temporal bone is the most common cause.
Accidental trauma is thought to be the commonest causes of CSF Otorrhoea.
CSF otorrhoea arising from defects in the tegmen and middle fossa dura can be managed by an intracranial repair, extracranial transmastoid or a combined approaches offer advantages in direct visualization and precise intra-and /or extra-dural, intra-cranial placement of a graft secured by sutures.
Here we are describing a case of CSF otorrhoea following mastoid surgery, treated with closure of the defect with cartilage by double layed technique with very good result.
Role of CT scan is of immense value, particularly useful in CSF rhinorhea and CSF otorrhoea cases in finding out the exact site of bone injury and thus useful in their management.