Meningitis may be the sole presenting sign of a cerebrospinal fluid (CSF) fistula of the temporal bone. An eight-year-old boy suffering from recurrent meningits was found to hav ebilateral severe cochlear dysplasia. Bilateral tympanotomies were performed, planning to obliterate each vestibule. In the right ear a stapedectomy was oerfirned, resulting in terrntial ‘CSF gusher’ and difficulty in packing the vestibule. CSF rhinorrhoea requiring revision surgery and twon episodes of gram-negative bacterial meningtis complicated the post-operative management, resulting in a prolonged hospital stay. Subsequently, the left ear was managed in a different fasion, leaving the stapes in situ, with grafts placed to seal the oval window nche. We would recommended this alternative procedure in cases of severe cochlear dysplasia, where abnormalities of the vestibule and basal turn of the cochela mean that performing a stapeddectomy to pack the vestibule may result in a severe ‘CSF gusher’, by opening directly into the subarachnoid space.
