Tegmen Defect Repair under Local Anesthesia

Introduction: Defects in the tegmen tympani can have serious consequences, such as intracranial infection and seizures, however, they can be difficult to diagnose due to their subtlety on cross-sectional imaging and the nonspecific way in which they can present. Repair of such defects can be undertaken via a middle fossa or transmastoid approach, both however usually necessitate a general anesthetic, middle cranial fossa surgery carries the risk of epilepsy and transmastoid repair can result in the loss of hearing. Patient: We present a novel method of repair in a patient who would otherwise have been managed conservatively. Methods: A 60-year-old obese patient with significant comorbidities presented with recurrent seizures and slowly resolving dysphasia. HRCT and MRI confirmed the presence of a tegmen defect. Transmastoid repair was undertaken under local anesthesia using a three layer autograft. Results: The transmastoid repair was successful without intraprocedure or postprocedure complications. Pure tone audiometry confirmed an improvement in the patients hearing thresholds. Conclusion: This case illustrates the clinical and technical diagnostic difficulties of diagnosing a tegmen defect. It demonstrates that transmastoid repair of a tegmen defect under local anesthesia is potentially a safe and effective procedure, which can be utilized in patients who would not otherwise be considered fit for surgery.