Factitious hearing loss and otorrhea in an adolescent boy

Asialo, or beta(2), transferrin occurs in cerebrospinal fluid and a few other body fluids, e.g., perilymph and aqueous humor. It is used clinically as a marker protein to detect CSF otorrhea and rhinorrhea. Asialo-transferrin is separated from sialylated serum transferrin glycoforms by electrophoresis and detected by Western blotting. Potential pitfalls in interpreting Western blots occur when other transferrin isoforms approximate the migratory behavior of asialo-transferrin. In the present report an adolescent boy was seen by an otolaryngologist for otorrhea and acute hearing loss. The otorrhea fluid, subsequently identified as saliva, contained a transferrin isoform with electrophoretic mobility similar to that of asialo-transferrin.