Persistent otorrhea due to spontaneous defect of the lateral skull base – diagnostics and therapy

Defects of the lateral skull base with otoliquorrhea are often caused by trauma, whereas spontaneous symptoms without trauma or malformation of the inner ear such as Mondini dysplasia or large vestibular aquaeduct syndrome are quite rare.

Three female patients aged 35 to 63 suffered from prolonged mucotympanon and an intermittent or persistent otorrhea after implantation of a ventilation tube. Microbiological testing revealed Staphylococcus aureus infection in two cases. The use of local antibiotics only temporarely improved otorrhea. There was a delay of up to five years until diagnosis of liquorrhea by β-trace-testing. In all of the three cases thin-slice CT-scans of the temporal bone proved a bony defect, but there was no evidence of underlying intracranial pathology in the MRI-scan. During mastoidectomy the skull base defect was identified and properly covered. In one case newly occured epileptical seizures of unknown origin were the initial cause for radiological imaging which led to the diagnosis of skull base defect. Intraoperatively brain parenchyma visibly prolapsed into the lateral skull base defect. Also in the second patient neuroglial tissue prolapsing into the defect was observed, but without clear findings in the MRI.

Persistent otorrhea without response of therapy should lead to early suspicion of liquorrhea and β-trace-test has to be conducted despite the absence of trauma in the patient’s history. Liquor leaks of the lateral skull base require a timely surgical covering in order to reduce the risk of otogenic meningitis. A pre-operative MRI is mandatory to exclude intracranial causes for the defect and to detect prolapsing dura or even brain tissue.

Poster-PDF A-1059.pdf

Publication History

Article published online:
13 May 2021