[Recurrent meningitis in inner ear malformations]

Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea

Objective: A cohort of patients with spontaneous cerebrospinal fluid (sCSF) otorrhoea. To report surgical outcome and discuss a treatment protocol.

Materials and Methods: Between 2012 and 2018 all patients presenting with sCSF were collected and data assessment was performed including clinical symptoms (hearing loss, aural fullness, meningitis, recurrent otitis media), preoperative audiometry, CT and MRI scanning. According to the site and size of the dural defect, different surgical approaches were applied.

Results: A total of 12 patients (14 operations) were included. Four of these had a history of meningitis. All beta-trace protein testings were positive. These patients were treated with different surgical approaches: middle fossa approach (MCF, seven patients), transmastoid approach (TMA) with bony obliteration of the cavity (three patients), and four patients underwent a subtotal petrosectomy (STP) procedure. Three cases underwent revision surgery (MCF or STP) due to residual disease (CFS leakage). After follow up duration of 13 months (6.5 months SD), no recurrence was observed. No severe adverse events such as cerebrovascular injury, meningitis, wound infection, or headache was observed in the postoperative course.

Conclusion: Spontaneous aural cerebrospinal fluid leakage is a rare but manageable pathology with potential severe complications. Appropriate diagnosis, laboratory testing, and imaging is primordial to obtain optimal patient outcome.

Lateral petrosectomy with obliteration cavity for spontaneous cerebrospinal otorrhea in children

PURPOSE

The most common causative factors of CSF otorrhea in children are injuries and congenital abnormalities of the temporal bone. Spontaneous CSF leak as a consequence of congenital temporal bone defects may result in recurrent meningitis. Diagnosis and management of such an entity are particularly difficult in early childhood.

MATERIALS AND METHODS

The aim of this study was to investigate clinical features and to discuss possible methods of treatment of spontaneous CSF otorrhea in children.

RESULTS

Severe unilateral sensorineural hearing loss or total deafness was found in children with CSF otorrhea. CT and MRI of the temporal bones revealed dehiscences in the walls of the tympanic cavity and defects of the inner ear, which were confirmed intraoperatively. Lateral petrosectomy and closure of the fistula with muscle tissue and fat obliteration cavity were performed. The children remain free of otorrhea and recurrences of meningitis.

CONCLUSION

The diagnosis of spontaneous otorrhea in children is based on the severe unilateral sensorineural hearing loss and presence of CSF in the middlę ear cavity. It may be successfully treated by means of lateral petrosectomy with obliteration of the vestibule with muscle tissue and tympanic cavity with fat tissue.