A case of spontaneous CSF otorrhea associated with recurrent meningitis (author's transl)

A 5-year-old girl was admitted to our hopsital on June, 1972, because of meningitis and CSF otorrhea. She had not suffered from head trauma or otological infective disease. Right temporal craniotomy was carried out on October, 1972, but no pathological findings on the anterior surface of the petrous bone was detected, so, the right middle ear bottom was packed with fascia graft by otologist, which stopped the CSF otorrhea for seven months. But the otorrhea recurred on June, 1973, when she caught cold. She was readmitted to our hospital because of recurrent meningitis. On November 7, 1973, when the meningitis abated, posterior fossa exploration was performed microsurgically. Strong arachnoid adhesion due to recurrent meningitis and enlargement of the right internal auditory meatus was observed. Probe could be inserted into the internal auditory meatus easily at a depth of 1.5 cm. Saline which was injected into the meatus from the probe flowed into the right middle ear. So the internal auditory meatus was packed with Gelfoam and muscle piece. By means of this procedure, CSF otorrhea was healed completely. Spontaneous CSF otorrhea, which was initially reported in 1897 by Escat, is a very rare disease. Only 15 cases have been reported in the literature. Two main possible routes of CSF leakage were reported, the one is via the internal auditory meatus, the other is via the cochlear aqueduct (Fig. 3). The former cases were more frequent than the latter. Our case belongs to the former type. (Fig. 4)