Unusual Case of Unilateral Otoliquorrhoea

Overview

Otoliquorrhoea is as a rule associated with a history of an injury, previous surgicaloperation on the temporal bone, chronic otitis, possibly a tumour of the temporal bone. Cases ofspontaneous otoliquorrhoea are usually associated with a defect of the temporal osseous wall of theposterior cranial fossa with possible development of a fistula, meningocele, or meningoencephalo-cele (in adult patients). Mondini’s dysplasia with penetration of liquor through the fenestra ovalisacross a defect of the dura mater in the internal auditory meatus is described in child patients. Theinitial symptoms may be similar as in chronic secretory otitis - conduction hypacusia and a B curveon tympanometry. The incidence of intracranial complications (meningitis) is reported in 20 - 25%of patients, more frequently in child patients. Diagnostic methods are CT, MR, possibly contrastexaminations.In the paediatric hospital in Brno at the Paediatric ENT Clinic the authors had a case of otoliquor-rhoea in a patient after bilateral antromastoidectomy (1992). In 1995 - 1998 on both sides fluid wasremoved from the middle ear and ventilation tubes were inserted. After the last insertion ofa ventilation tube in 1998 discharge of liquor occurred. Subsequent CT of the pyramids revealed onthe right side a postoperative defect of the mastoid process near the posterior cranial fossa and animpaired outline of the pyramid on the ventral side and communication of the defect with the middleear cavity. During surgical revision of the right middle ear a perforated meningocele was foundwhich emerged from a defect of the tegmen tympani bone. The sac of the meningocele was resectedand the diagnosis was confirmed by histological examination. The bone defect was covered bya patch from a fascia of the m. temporalis, Zenoderm and an osseous bridge. During treatment noacute inflammatory complications developed. Since the operation the patient is for more than oneyear free from complaints.

Key words:
otoliquorrhoea, meningocele, Mondini’s dysplasia, CT of the pyramids.