Tags

Type your tag names separated by a space and hit enter

Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases.
J Zhejiang Univ Sci B. 2019 Feb.; 20(2):156-163.JZ

Abstract

OBJECTIVE

To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia.

METHODS

A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented.

RESULTS

The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair.

CONCLUSIONS

CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament.

Authors+Show Affiliations

ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China. Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30666849

Citation

Wang, Bing, et al. "Cerebrospinal Fluid Otorrhea Secondary to Congenital Inner Ear Dysplasia: Diagnosis and Management of 18 Cases." Journal of Zhejiang University. Science. B, vol. 20, no. 2, 2019, pp. 156-163.
Wang B, Dai WJ, Cheng XT, et al. Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. J Zhejiang Univ Sci B. 2019;20(2):156-163.
Wang, B., Dai, W. J., Cheng, X. T., Liuyang, W. Y., Yuan, Y. S., Dai, C. F., Shu, Y. L., & Chen, B. (2019). Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. Journal of Zhejiang University. Science. B, 20(2), 156-163. https://doi.org/10.1631/jzus.B1800224
Wang B, et al. Cerebrospinal Fluid Otorrhea Secondary to Congenital Inner Ear Dysplasia: Diagnosis and Management of 18 Cases. J Zhejiang Univ Sci B. 2019 Feb.;20(2):156-163. PubMed PMID: 30666849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. AU - Wang,Bing, AU - Dai,Wen-Jia, AU - Cheng,Xiao-Ting, AU - Liuyang,Wen-Yi, AU - Yuan,Ya-Sheng, AU - Dai,Chun-Fu, AU - Shu,Yi-Lai, AU - Chen,Bing, PY - 2019/1/23/entrez PY - 2019/1/23/pubmed PY - 2019/5/14/medline KW - Cerebrospinal fluid; Abnormality; High-resolution computed tomography (HRCT); Congenital inner ear dysplasia; Otorrhea; Meningitis SP - 156 EP - 163 JF - Journal of Zhejiang University. Science. B JO - J Zhejiang Univ Sci B VL - 20 IS - 2 N2 - OBJECTIVE: To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia. METHODS: A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented. RESULTS: The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair. CONCLUSIONS: CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament. SN - 1862-1783 UR - https://www.unboundmedicine.com/medline/citation/30666849/Cerebrospinal_fluid_otorrhea_secondary_to_congenital_inner_ear_dysplasia:_diagnosis_and_management_of_18_cases_ L2 - http://www.jzus.zju.edu.cn/article.php?doi=10.1631/jzus.B1800224 DB - PRIME DP - Unbound Medicine ER -