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Published on: February 29, 2020
Spontaneous cerebrospinal fluid otorrhoea presenting as otitis externa
1ENT Department, Staffordshire General Hospital NHS Trust, Stafford, UK. alextoh@doctors.org.uk
Summary
A rare case of spontaneous cerebrospinal fluid (CSF) otorrhoea, initially misdiagnosed as otitis externa, highlights diagnostic challenges. Surgical repair via a transmastoid approach successfully treated the CSF leak and middle ear encephalocele.
Area of Science:
- Otolaryngology
- Neurosurgery
- Neurology
Background:
- Spontaneous cerebrospinal fluid (CSF) otorrhoea is a rare condition involving leakage of CSF into the ear.
- It can be misdiagnosed as common ear infections like otitis externa, delaying appropriate treatment.
- Middle ear encephalocele, a protrusion of brain tissue into the middle ear, is a common cause of spontaneous CSF otorrhoea.
Observation:
- A 59-year-old female presented with otorrhoea initially treated as chronic otitis externa.
- Further investigation revealed the otorrhoea was due to a spontaneous CSF leak associated with a middle ear encephalocele.
- The patient's symptoms resolved after surgical repair.
Findings:
- The case highlights the importance of considering CSF otorrhoea in patients with persistent or unusual ear discharge.
- Diagnostic pitfalls include the non-specific nature of otorrhoea and the rarity of the condition.
- A transmastoid approach using fascia, bone pâté, and fibrin glue was effective for surgical repair.
Implications:
- Early and accurate diagnosis of CSF otorrhoea is crucial to prevent complications such as meningitis.
- This case underscores the need for a high index of suspicion for CSF leaks in otological practice.
- Understanding the pathophysiology and diagnostic challenges can improve patient outcomes for this rare condition.
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