Case Report

Spontaneous CSF Otorrhea Masquerading as Middle Ear Effusion: A Case Report

Abstract

Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare but important differential diagnosis in cases of persistent middle ear effusion. We report a case of a 45-yearold female who presented with persistent aural fullness and hearing loss in the right ear immediately following an airplane flight. She was initially diagnosed with middle ear effusion and underwent myringotomy with grommet ventilation tube insertion. However, the patient continued to experience profuse watery otorrhea for two months postoperatively. Subsequent computed tomography of the temporal bone confirmed a CSF leak from a defect in the tegmen tympani near the anterior epitympanum. The patient underwent successful endoscopic CSF otorrhea repair under general anaesthesia. Three months postoperatively, the patient’s hearing improved, and her aural symptoms resolved. This case highlights the importance of considering spontaneous CSF leaks in cases of sudden-onset conductive hearing loss, even in the absence of trauma or prior surgical history.

[1] Meco C, Oberascher G. Comprehensive algorithm for skull base dural lesion and cerebrospinal fluid fistula
diagnosis. Laryngoscope. 2004;114(6):991-9. https://doi.org/10.1097/00005537-200406000-00007
[2] Ferguson BJ, Wilkins RH, Hudson W, Farmer J Jr. Spontaneous CSF otorrhea from tegmen and posterior fossa
defects. Laryngoscope. 1986;96(6):635-44. https://doi.org/10.1288/00005537-198606000-00009
[3] Wackym PA, King WA, Senne AJ, Matz GJ. Cerebrospinal fluid fistula through a congenital defect of the lateral wall of the internal auditory canal. Am J Otol. 1996;17(1):144-7.
[4] Brophy BP, Jackler RK, Dillon WP. Use of gadolinium-enhanced magnetic resonance imaging in the evaluation of persistent cerebrospinal fluid otorrhea. Otolaryngol Head Neck Surg.1997;117(6):611-8.
[5] 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(5):800-5. https://doi.
org/10.1097/00005537-200405000-00002
[6] Oney RM, Sloneker DR, Bloom AG, Avillion MP, Crawford JV, Chen BS. Cerebrospinal fluid otorrhea after a routine
tympanostomy tube placement: a review of the literature on Hyrtl fissure. Ear Nose Throat J. 2022;0(0). https://doi.
org/10.1177/01455613211039045
[7] Roehm PC, Tint D, Chan N, Brewster R, Sukul V, Erkmen K. Endoscope-assisted repair of CSF otorrhea and
temporal lobe encephaloceles via keyhole craniotomy. J Neurosurg. 2018;128(6):1880-4. https://doi.
org/10.3171/2017.1.JNS161947
[8] Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol. 1998;19(4):633-9.
[9] Kutz JW Jr, Husain IA, Isaacson B, Roland PS. Management of spontaneous cerebrospinal fluid otorrhea.
Laryngoscope. 2008;118:2195-9. https://doi.org/10.1097/MLG.0b013e318182f833
[10] 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;114:800-5. https://doi.
org/10.1097/00005537-200405000-00002
[11] Rao AK, Merenda DM, Wetmore SJ. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea.
Otol Neurotol. 2005;26(6):1171-5. https://doi.org/10.1097/01. mao.0000179526.17285.cc
[12] Hendriks T, Bala A, Rodrigues S, Kuthubutheen J. Spontaneous cerebrospinal fluid (CSF) otorrhoea in Western Australia-an emerging entity? Aust J Otolaryngol. 2019 Feb 13 [online].https://doi.org/10.21037/ajo.2019.01.07
[13] Eljazzar R, Loewenstern J, Dai JB, Shrivastava RK, Iloreta AM. Detection of cerebrospinal fluid leaks: is there a
radiologic standard of care? A systematic review. World Neurosurg. 2019;127:307-15. https://doi.org/10.1016/j.
wneu.2019.01.299
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IssueVol 10 No 2 (2025): March-April QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v10i2.19898
Keywords
Spontaneous CSF otorrhea Middle ear effusion Myringotomy Endoscopic repair Tegmen tympani defect Cerebrospinal fluid leak
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How to Cite
1.
Vazhipokkil A, Kavathur V. Spontaneous CSF Otorrhea Masquerading as Middle Ear Effusion: A Case Report. CRCP. 2025;10(2):59-63.