AN ADULT CASE OF PERILYMPH GUSHER CAUSED BY HEAD CONTUSION

Takeshi Matsunobu, Daisuke Kamide, Atsushi Tamura, Takaomi Kurioka, Katsuki Niwa, Yuya Tanaka, Masayuki Tomifuji, Akihiro Shiotani

Department of Otolaryngology, Head and Neck Surgery, National Defense Medical College, Saitama, Japan

Here we report a rare adult case of cerebrospinal otorrhea triggered by head contusion in a 46-year old male. Riding his bicycle, he fell to the ground and bruised his head. A month after the accident he had watery rhinorrhea and suffered from fever and headache. He consulted a neurosurgeon at a nearby hospital and was diagnosed with meningitis. He was admitted to the hospital and was treated with an intravenous drip infusion therapy of antibiotics. The patient consulted an otolaryngologist in our department and was diagnosed with CSF leak with temporal bone fracture. He is naturally completely deaf. The balance test revealed no particular remarks. The clear fluid outflow from the pharyngeal orifice of Eustachian tube was observed by means of fiberscopy. Brain MRI, temporal bone targeted CT and RI cisternography strongly suggested a CSF leak with Mondini’s malformation of the inner ear and surgery was performed to explore the CSF leak and stop it. Mastoidectomy indicated no fracture. We found the fluid flow from the mesotympanum and finally found an extreme overflow of fluid from the footplate of the stapes. The stapes was removed and the vestibule was filled with fascia of temporal muscle and bone patty. About four years after the surgery, recurrence of CSF leak occurred and revision surgery was performed. The lesion of leakage was the same as the first surgery and the vestibule was filled with cartilage of the auricle and fascia. Although recurrent meningitis has sometimes been reported in patients with inner ear malformation, it is rare that head contusion is the trigger of a CSF leak from the inner auditory canal in an adult.

Address for correspondence: Takeshi Matsunobu, Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College 3–2 Namiki, Tokorozawa, Saitama 359–8513, Japan. takeshim@ndmc.ac.jp

Cholesteatoma and Ear Surgery – An Update, p. 475

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands