Eustachian Tube Obliteration for Temporal Bone Cerebrospinal Fluid Leaks

Temporal bone cerebrospinal fluid (CSF) leaks most commonly present as unilateral clear rhinorrhea or otorrhea and are often exacerbated by maneuvers that increase intracranial pressure. While a high index of clinical suspicion is essential, beta-2 transferrin remains the gold standard for confirming CSF in otorrhea or nasal secretions. When the Eustachian tube functions as the primary conduit for CSF egress, Eustachian tube obliteration (ETO) serves as an important adjunctive strategy for the management of high-flow or refractory leaks that fail conservative therapy. The transmastoid approach has historically been the workhorse technique for ETO and continues to be used successfully.