Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T08:47:46.105Z Has data issue: false hasContentIssue false
  • English
  • Français

Cerebrospinal fluid otorrhoea following grommet insertion: management using a multi-layered graft technique and an important lesson revisited

Published online by Cambridge University Press:  10 December 2012

S Patil ,
A Trinidade ,
M Yung  and
N Donnelly
S Patil
Affiliation:
Department of Otolaryngology, Ipswich Hospital, Ipswich, UK
A Trinidade*
Affiliation:
Department of Otolaryngology, James Paget Hospital, Gorleston, Great Yarmouth, UK
M Yung
Affiliation:
Department of Otolaryngology, Ipswich Hospital, Ipswich, UK
N Donnelly
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
*
Address for correspondence: Mr A Trinidade, Department of Otolaryngology, James Paget Hospital, Gorleston, Great Yarmouth NR31 6LA, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

A spontaneous cerebrospinal fluid leak can sometimes only become apparent following grommet insertion and usually represents dehiscence of the tegmen tympani, which is an uncommon condition.

Objectives:

This report aimed to reaffirm the importance of recognising this unusual presentation and outline management options.

Case report:

A 63-year-old man with conductive hearing loss and type B (flat) tympanometry underwent grommet insertion into his left ear, which resulted in cerebrospinal fluid otorrhoea. A defect of the tegmen tympani was found. This was successfully repaired via a transmastoid approach using a multi-layered grafting technique.

Conclusion:

Dehiscence of the tegmen tympani is uncommon and may only come to light following grommet insertion, which may be problematic for the uninformed otolaryngologist. Education is important to ensure early recognition and appropriate management.

Keywords

Tympanostomy Tube InsertionCerebrospinal FluidTemporal Bone
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 1 , January 2013 , pp. 70 - 72
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented orally at the 140th Semon Club, 19 November 2010, London, UK.

References

1 Pappas, DG, Pappas, DG, Hoffman, RA, Harris, SD. Spontaneous cerebrospinal fluid leaks originating from multiple skull base defects. Skull Base Surg 1996;6:227–30CrossRefGoogle ScholarPubMed
2 Brown, NE, Grundfast, KM, Jabre, A, Megerian, CA, O'Malley, BW Jr, Rosenberg, SI. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope 2004;114:800–5Google Scholar
3 Windfuhr, JP, Sesterhenn, K. Spontaneous defects of the lateral skull base. 2. Etiology and review of the literature [German]. HNO 2002;50:441–63Google Scholar
4 Gacek, RR, Gacek, MR, Tart, R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999;20:770–6Google Scholar
5 Puyraud, S, Sauvage, JP, Aubry, K. Cerebro-spinal fluid otorrhea and a spontaneous defect of the tegmen tympani or antri. A report of 3 cases. Role of arachnoid granulations. Rev Laryngol Otol Rhinol (Bord) 2003;124:247–53Google Scholar
6 Vezina, JP, Audet, N, Fradet, G. Cerebrospinal fluid otorrhoea: a rare presentation of Langerhans' cell histiocytosis of the temporal bone. J Laryngol Otol 2010;124:545–8Google Scholar
7 Rich, PM, Graham, J, Phelps, PD. Hyrtl's fissure. Otol Neurotol 2002;23:476–82Google Scholar
8 Dutt, SN, Mirza, S, Irving, RM. Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate. Clin Otolaryngol Allied Sci 2001;26:117–23Google Scholar
9 Kveton, JF, Goravalingappa, R. Elimination of temporal bone cerebrospinal fluid otorrhea using hydroxyapatite cement. Laryngoscope 2000;110:1655–9Google Scholar
10 Siedentop, KH, O'Grady, K, Park, JJ, Bhattacharya, T, Sanchez, B. Fibrin sealant for treatment of cerebrospinal fluid leaks. Am J Otol 1999;20:777–80Google ScholarPubMed

Patil st al. supplementary movie

Movie

Download Patil st al. supplementary movie(Video)
Video 55 MB