Cerebrospinal fluid otorrhea (leakage ear)

Ear Nose | Otorhinolaryngology | Cerebrospinal fluid otorrhea (leakage ear) (Disease)


Description

Cerebrospinal fluid (CSF) through the ear structures is a rare but potentially life-threatening situation that requires rapid intervention.

Causes and Risk factors

CSF otorrhea occurs on the basis of skull fracture, tumor, infections, congenital anomalies, benign or malignant neoplasms and operative trauma. CSF otorrhea occurs only if a perforation in the eardrum or a defect in the external ear canal is present.

This is often the case when the leakage results from trauma or previous ear surgery. Congenital or spontaneous CSF leaks are thought to arise from the congenital bony defect theory or from the arachnoid granulation theory. Spontaneous leakage is leakage that occurs without an obvious antecedent pathology. Such leakage is usually due to some congenital defect in the temporal bone. Meningitis is often the presenting symptom. Sensorineural hearing loss and seizures are potential morbidity.

Diagnosis and Treatment

Patients suspected of having a spinal fluid leakage should undergo complete otologic, neurologic, and head and neck examination. Computer tomography scan can demonstrate the course of the fracture line and give information as to the likely site of CSF fistula.

Surgical repair is recommended for those cases that do not resolve in order to prevent the morbidity and mortality associated with meningitis. The successful management of a patient with a history suggestive of a CSF leak involves ensuring that it is a true leak by testing the fluid for beta-2-transferrin. ...