CSF otorrhea

Last revised by Francis Deng on 7 May 2020

CSF otorrhea is defined as leakage of cerebrospinal fluid (CSF) from the subarachnoid space into the middle ear cavity or mastoid air cells and then out the ear via a perforation in the tympanic membrane or defect in the external ear.

There are a number of underlying causes, and thus no specific demographic is affected. 

Patients typically present with conductive deafness and a watery discharge from the ear (requiring a defect in the tympanic membrane).

The diagnosis can be confirmed by identifying beta-2 transferrin in the fluid.

Findings on CT cisternography include:

  • soft tissue mass with adjacent bony defect
  • leakage of contrast into middle ear cavity
  • bony defects
  • labyrinthine malformations
  • fistulous tracts 
  • enlarged labyrinthine facial nerve canal

Findings include:

  • CSF signal intensity in the bony defects
  • CSF signal intensity in middle ear cavity
  • associated empty sella
  • dural enhancement after gadolinium administration

In complex cases, nuclear cisternography may be performed.

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