Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 59 63 Anoop Vazhipokkil Department of ENT and Head Neck Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. Vishwanathan Kavathur Department of ENT and Head Neck Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. 2025 06 25 2025 08 27 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. https://crcp.tums.ac.ir/index.php/crcp/article/view/1059 https://crcp.tums.ac.ir/index.php/crcp/article/download/1059/715