Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases

Rare Cases of Cerebrospinal Fluid Oto-Rhinorrhoea in Patients with Congenital Inner Ear Malformations

Spontaneous cerebrospinal fluid (CSF) oto-rhinorrhoea is rare and may develop secondary to inner ear malformation. Any child discharging watery fluid through nose or ear spontaneously in a head dependent position should be a high index of suspicion of CSF leak. If watery rhinorrhoea is present then apart from biochemical analysis of fluid discharge to confirm it to be CSF, computed tomography of paranasal sinuses and temporal bone should be carried out to differentiate between CSF oto-rhinorrhoea and CSF rhinorrhoea. Congenital deformities of the inner ear can be associated with meningitis and varying degrees of hearing loss. Here we describe two cases, one of CSF oto-rhinorrhea in a 1 year old child who presented with spontaneous watery rhinorrhoea following violent projectile vomiting of 1 month duration. On evaluation, child was found to have CSF oto-rhinorrhoea with right Mondini deformity and profound hearing loss on right side. 2nd case was of 12 years old male with profound hearing loss right ear and recurrent episodes of meningitis diagnosed as common cavity malformation of inner ear. Both children underwent closure of CSF leak from oval window successfully. There was no recurrence after more than 1 year of follow up. Congenital inner ear malformations are an important cause of recurrent meningitis in children and require a high index of suspicion for diagnosis. Thorough clinical evaluation and radiological study is suggested in all cases of CSF oto-rhinorrhoea for the identification inner ear malformation and management of CSF oto-rhinorrhoea. Patients who receive an accurate and early diagnosis can avoid severe complications and have a good prognosis.

Analysis of 3 Surgical Approaches for the Treatment of Cerebrospinal Fluid Otorrhea: A Case Series Report

Background: This case series report aimed to present three surgical approaches used for the treatment of cerebrospinal fluid (CSF) otorrhea, providing less invasive surgical options for managing this condition. Methods: Clinical data of 26 patients with CSF otorrhea, who underwent treatment using three surgical methods between June 2012 and June 2022, were retrospectively analyzed. The study collected information on patients' basic demographic characteristics, chief complaints, location of the defect, results of otorrhea endoscopic examination, findings from skull base thin-slice computed tomography (CT) examination, and causes of CSF otorrhea. Postoperative outcomes of CSF otorrhea were followed up. Results: Among the 26 cases of CSF otorrhea, there were 13 (50%) males and 13 (50%) females who underwent treatment using the three surgical methods. The etiology of CSF otorrhea included 10 (38%) cases of spontaneous CSF otorrhea, including 2 (8%) cases of congenital inner ear deformity and 8 (31%) cases without obvious inducement. Additionally, there were 5 (19%) cases of trauma, 6 (23%) cases of cholesteatoma complications, 3 (12%) cases of postoperative complications of brain tumor, 1 (4%) case of radiotherapy, and 1 (4%) case of a malignant tumor. A total of 12 (46%) cases of CSF otorrhea were treated by local repair of the defect. Furthermore, 3 (12%) cases underwent local repair of the defect combined with sealing of the tympanic sinus entrance, while 11 (42%) cases underwent local repair of the defect combined with sealing of the eustachian tube and the external auditory canal. No recurrence of CSF otorrhea was observed during the 6-month to 10-year follow-up period after surgery. Conclusion: The three methods for CSF otorrhea, including local defect repair, local defect repair combined with sealing of the tympanic sinus entrance, and sealing of the eustachian tube and the external auditory canal, demonstrated successful outcomes in appropriately selected patients.

[Surgical methods of cerebrospinal fluid otorhinorrhea due to inner ear malformation in children]

Objective:To discuss the application of two surgical methods, trans-mastoid approach and trans-canal endoscopic approach, in the treatment of CerebroSpinal Fluid（CSF） otorhinorrhea due to inner ear malformation（IEM） in children. Methods:Children with CSF otorhinorrhea due to IEM, from July 2015 to Jan 2021, in ENT department, Beijing Children's Hospital were retrospectively analyzed, and the clinical data, surgical methods, complications, recurrence and follow-up were recorded. Results:30 children with CSF otorhinorrhea due to IEM were included. Half of them had a history of otorhinorrhea, and 53.3% of them were diagnosed as cerebrospinal fluid（CSF） otorrhea at the first onset Unilateral and bilateral IEM were 22 cases and 8 cases respectively. All unilateral IEM children had secondary infections such as meningitis or/and pneumonia, and 9.1% had cochlear implantation（CI） due to deafness after meningitis. 87.5% bilateral IEM children had CI due to profound/severe hearing loss. 96.7% CSF otorhinorrhea were unilateral, there was no relationship between CSF otorhinorrhea and the malformation side or the time of CI surgery. Trans-mastoid approach was used in 14 cases, usually involving CI or other operations; and endoscopic approach in 16 cases. The age of trans-mastoid group was younger than that of endoscopic group. No recurrence and complications occured in the trans-mastoid group. In the endoscopic group, 2 cases recurred; 3 cases had complications（2 with temporary facial paralysis and 1 with labyrinth and intracranial pneumatosis）. Except one case lost, the others were followed up for 1.2-6.7 years, and no recurrence of pneumonia, meningitis and CSF otorhinorrhea happened. Conclusion:Unilateral IEM usually leads to meningitis or/and pneumonia, and bilateral IEM requires CI. Both trans-mastoid and trans-canal endoscopic approach were effective for CSF otorrhea repair. Trans-mastoid approach is suitable for those who need mastoid exploration, CI or combined with other operations. Trans-canal endoscopic approach was choosed when fistula was confined to the tympanum and ear canal diameter was wide enough.

[Progress in diagnosis and treatment of cerebrospinal fluid otorrhea caused by inner ear malformation]

Cerebrospinal fluid otorrhea caused by inner ear malformation is rare, and its clinical manifestations are atypical. Therefore, it can easy be misdiagnosed or missed. Recurrent meningitis caused by inner ear malformation can lead to serious complications. This article reviews the classification of inner ear malformation, the etiology the common fistula locations, clinical features, imaging features, surgical approaches, postoperative complications and influencing factors of surgical efficacy of cerebrospinal fluid otorrhea due to inner ear malformation.

A case report of cerebrospinal fluid leak secondary to inner ear malformation

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is rare and may develop secondary to inner ear malformation. A possible diagnosis of CSF leak should be considered in any pediatric patient who presents with hearing impairment, rhinorrhea, or otorrhea. Temporal bone computed tomography should be performed in children with hearing impairments. We describe a case of congenital inner ear anomaly in a 12-month-old girl who presented with intermittent rhinorrhea after birth and detected hearing problems when she was 6 months. After diagnosis, the CSF leak was surgically repaired without complications.

Cryptococcus neoformans in a child with CSF rhinorrhoea: A cytopathological diagnosis

Cryptococcosis is caused by Cryptococcus neoformans and is fatal in children. The fungus is known to enter respiratory tract by inhalation and localizes in lungs in immunocompetent host. Patients with immunocompromised state facilitate dissemination of disease. However, disseminated cases have been described in immunocompetent HIV-negative individuals. CSF rhinorrhoea as a predisposing cause of cryptococcal meningitis has been rarely reported. We hereby describe C. neoformans directly spreading to the meninges in 1 year child due to CSF rhinorrhoea and the fungus was detected on fluid cytology.

Congenital Membranous Stapes Footplate Producing Episodic Pressure-Induced Perilymphatic Fistula Symptoms

Introduction: Recent third window syndrome studies have revealed that the intact bony labyrinth and differences in the stiffness of the oval and round windows are essential for proper cochlear and vestibular function. Herein we report a patient with a congenital dehiscence of the right stapes footplate. This dehiscence caused long-standing episodic pressure-induced vertigo (Hennebert sign). At the time of presentation, her increased thoracic pressure changes induced the rupture of the membranous stapes footplate. Perilymph leakage was confirmed by imaging and a biochemical test [perilymph-specific protein Cochlin-tomoprotein (CTP) detection test].

Case Report: A 32-year-old woman presented with a sudden onset of right-sided hearing loss and severe true rotational vertigo, which occurred immediately after nose-blowing. CT scan showed a vestibule pneumolabyrinth. Perilymphatic fistula (PLF) repair surgery was performed. During the operation, a bony defect of 0.5 mm at the center of the right stapes footplate, which was covered by a membranous tissue, and a tear was found in this anomalous membrane. A perilymph-specific protein CTP detection test was positive. The fistula in the footplate was sealed. Postoperatively, the vestibular symptoms resolved, and her hearing improved. A more detailed history revealed that, for 15 years, she experienced true rotational vertigo when she would blow her nose. After she stopped blowing her nose, she would again feel normal.

Discussion: There is a spectrum of anomalies that can occur in the middle ear, including the ossicles. The present case had a dehiscence of the stapes, with a small membranous layer of tissue covering a bony defect in the center of the footplate. Before her acute presentation to the hospital, this abnormal footplate with dehiscence induced pathological pressure-evoked fluid-mechanical waves in the inner ear, which resulted in Hennebert sign. When patients have susceptibility (e.g., weak structure) to rupture, such as that identified in this case, PLF can be caused by seemingly insignificant events such as nose-blowing, coughing, or straining.

Conclusion: This case demonstrates that PLF is a real clinical entity. Appropriate recognition and treatment of PLF can improve a patient's condition and, hence, the quality of life.

Diagnosis and management of pediatric cerebrospinal fluid leakage secondary to inner ear malformations: A report of 13 cases

OBJECTIVES

Inner ear malformations (IEM) with cerebrospinal fluid (CSF) leakage in children is a rare condition, nevertheless, it may lead to meningitis. Early diagnosis and treatment are crucial. The aims of the study were to summarize the clinical characteristic of pediatric CSF leakage secondary to IEM, and to recommend transcanal endoscopic ear surgery (TEES) as an effective surgical technique for the treatment of CSF leakage with IEM in children.

METHODS

This was a retrospective study. Thirteen children and fourteen ear surgery were included. Demographics, detail history, laboratory data, Audio test, and imageological examination results were recorded. All the pediatric patients underwent TEES.

RESULTS

Most (92.31%) of the children presented with a history of rhinorrhea. 69.23% (9/13) of the children had suffered from meningitis, and the other had presented with respiratory tract infections. The follow-up duration ranged from 0.75 years to 5.29 years. Transcanal endoscopic repair of CSF leakage secondary to IEM was the first surgery with a success rate of 92.86% (13 out of 14 cases). A fistula could be found in the stapes footplate in all pediatric patients.

CONCLUSION

Even if there has been no history of meningitis, the diagnosis of CSF leakage in children suffering from unilateral rhinorrhea and recurrent respiratory tract infection is considered. Auditory brainstem response (ABR) and Temporal bone computed tomography (CT) examinations are suggested to identify IEM. The TEES procedure is recommended in our study as the first choice that repairs CSF leakage secondary to IEM.

Frontiers in auditory bioscience and technology: a special feature on recent advances in hearing research

Hearing impairment has become one of the most common sensory disabilities. The World Health Organization (WHO) estimates that 466 million people were living with disabling hearing loss in 2018, and that number could rise to 900 million by 2050. Conductive hearing loss, which predominantly involves the sound-transmitting route of the outer and middle ear, has been well handled by antibiotics and surgery. However, sensorineural hearing loss, which involves the inner ear and structures further within the auditory pathway, has very limited biological treatment options (current treatment options include only hearing amplification and cochlear implants). Part of the reason for the paucity of therapeutics is due to the complexity of the auditory system and the limited regenerative ability of the hearing sensory cells, hair cells, and connected nerve.