Spontaneous Bilateral Aural Leak of Cerebrospinal Fluid

Background and Aim: A CSF leak indicates dural injury. When the tegmen tympani is involved we have either fluid in the middle ear or in cases where the tympanic membrane is ruptured, liquorrhea through the external canal. In most cases the tears of the dura of the lateral skull base heal spontaneously.

Case Report: A 58-year-old woman presented with aural fullness, annoying tinnitus, and conductive hearing loss in both ears 5 years ago. She was initially treated by different ENT doctors for otitis media with effusion, and for this reason underwent many surgeries with no success (seven procedures to insert grommets in her right ear and five such procedures in her left ear). She developed a spontaneous extensive leak of an almost clear fluid from both ears that has endured for the last 3 years, immediately after insertion of grommets, with small asymptomatic intervals. Even though we were not sure about the nature of the fluid, we suspected it to be cerebrospinal. Liquorrhea from her left ear stopped spontaneously 1 year ago. There is no history of previous otologic surgery, but she referred to a head injury during a lethal car accident when she was 12 years old. A high-resolution CT scan has recently revealed the site of a small defect at the tegmen tympani of the right ear and a much smaller one in the left ear, which could be “invisible” without the clinical suspicion. Two previous CT scans revealed no pathology, other than chronic inflammation of the right mastoid cavity. We have recently found a small degree of conductive hearing loss at her right ear, and tympanometry revealed type B diagram at the same ear.

Conclusion: There are two different surgical approaches. The first one includes a mastoidectomy approach and the second one a neurosurgical transtemporal approach. The patient chose the second one. She did not present any pathological symptoms and had complete recovery of hearing 20 days after her surgery.