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Spontaneous CSF otorrhoea - Presenting as conductive deafness

Rajeev Pachauri1, Smita Nagaonkar, M V Kirtane

  • 1Dept. of ENT & Head & Neck Surgery, P.D. Hinduja National Hospital & Medical Research Center, 1SI Floor, Old Building, Veer Savarkar Marg, Mahim, 400 016 Mumbai.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|November 3, 2012
PubMed

Insights

Spontaneous cerebrospinal fluid (CSF) otorrhea is rare, especially in older adults. This case highlights diagnosis and successful surgical repair of a rare spontaneous CSF leak, preventing recurrence.

Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Medical Diagnostics

Background:

  • Spontaneous cerebrospinal fluid (CSF) otorrhea is uncommon, particularly in adults.
  • Congenital inner ear malformations are a frequent cause in children, while adults may present with otorrhea following trauma or spontaneously.
  • Typical presentations differ between age groups, with pediatric cases often linked to meningitis and adult cases showing watery nasal or ear discharge.

Purpose of the Study:

  • To report a rare case of spontaneous CSF otorrhea in an adult.
  • To illustrate the diagnostic process, including the use of B2-transferrin testing.
  • To describe the successful surgical management and outcomes.

Main Methods:

  • A case presentation of an adult patient with conductive deafness and negative middle ear pressure.
  • Initial misdiagnosis as secretory otitis media, leading to grommet insertion.
  • Confirmation of CSF otorrhea via B2-transferrin assay of middle ear fluid.
  • Surgical intervention using a post-aural transmastoid approach to seal the defect.

Main Results:

  • B2-transferrin levels confirmed the diagnosis of CSF otorrhea.
  • Surgical repair of the dural defect was successfully performed in layers.
  • The patient remained asymptomatic with no recurrence during follow-up.

Conclusions:

  • Spontaneous CSF otorrhea requires a high index of suspicion for accurate diagnosis in adults.
  • B2-transferrin testing is crucial for confirming CSF leaks.
  • Surgical repair via a transmastoid approach is an effective treatment for spontaneous CSF otorrhea.

Keywords:
Arachnoid granulationDehiscenceSpontaneousVentilation

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