Spontaneous Cerebrospinal Otorrhea

Abstract

The spontaneous discharge of cerebrospinal fluid from the nose was first positively established as a pathologic possibility by St. Clair Thomson1 in 1899. Since the publication of his monograph, reports of a considerable number of cases have appeared in the literature, although it is still regarded as an exceedingly infrequent condition.It has long been known that cerebrospinal fluid may escape from the ear after fractures of the base of the skull or following operations during which the inner ear or subdural space has been opened, but the literature dealing with spontaneous cerebrospinal otorrhea is apparently meager.Canfield,2 in 1913, reported a case of escape of cerebrospinal fluid and pus from the ear with no history of trauma, but the condition was preceded by pain in the ear for six weeks and impaired health for six months. The report of the autopsy was as follows:A plastic basal meningitis. The apex of the right temporal bone was occupied by a very large pneumatic cell containing cerebrospinal fluid and pus. The perforation through the wall of this cell had permitted the entrance of infection to the subdural space and the escape of cerebrospinal fluid externally into the pneumatic structure of the temporal bone, thence to the middle ear and external canal. Canfield in the same paper reported certain findings during an operation on the labyrinth which are of interest in connection with the case that I am presenting. Following is a quotation from his observations:The cerebellum was uncovered and an attempt made to open the labyrinth from behind. On account of the escape of cerebrospinal fluid from a small circular opening in the dura, which was probably a large perilymphatic duct opening atypically into the subdural space, this stage of the operation was not permitted.Although the hole in the dura was obliterated by a suture, the postoperative flow of cerebrospinal fluid was profuse and persistent until a

Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults

“…Postoperatively, two more patients subsequently developed meningitis . Four never had meningitis . Of note, all cases of meningitis occurred prior to 1971.…”

“…3,8 Four never had meningitis. 3,6,7 Of note, all cases of meningitis occurred prior to 1971. It is difficult to determine how access to health care, antibiotics, and surgical techniques may have influenced patient presentation and course.…”

“…The earliest cases of CSF otorrhea were reported in 1897, 1913, and 1931 to 1934 . These cases are frequently cited in the early literature regarding CSF otorrhea.…”

A Third Labyrinthine Window: An Overview of Perilymph and Labyrinthine Fistulae and Superior Semicircular Canal Dehiscence

“…13 The first report of otorrhea with cerebrospinal fluid was by Escat in 1897, while in 1933 Kline reported another case of a 54-year-old male with clear fluid otorrhea. 14, 15 Lewis, in 1961, and Sheehy and House, in 1962, reported perilymph fistulas after stapedectomy, Fee, in 1968, after trauma, and Pullen, in 1979, after barotrauma in divers. [16][17][18][19] In 1970 Stroud and Calcaterra reported spontaneous leakage and in 1971, Goodhill stressed the point of a relationship between sudden hearing loss and round window rupture.…”

Spontane Defekte der seitlichen Schädelbasis Teil 2. Ätiologie und Literaturübersicht

“…Über einen letalen Verlauf einer Meningitis wurde erstmals von Canfield 1913und Kline 1933 berichtet [17,68].Weitere Berichte stammen von Hipskind, Schuknecht, Phelps, Leidinger (nach Tubendurchblasung) und Merchant [54,79,91,113,125] …”