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Oral Presentations to Cover Latest Developments in Otology, Neurotology

The benefits of the transmastoid approach to spontaneous temporal bone cerebrospinal fluid (CSF) leaks will be discussed during one of today’s scientific oral presentations on otology and neurotology.

Leslie Kim, MD, Columbus, OH, will help present “Transmastoid Approach to Spontaneous Temporal Bone CSF Leaks: Hearing Improvement and Success of Repair,” from 8:00 am to 9:20 am in West 302-303.

Spontaneous temporal bone CSF leakage is an uncommon clinical entity, but is often challenging to diagnose and manage. Definitive and expedited surgical repair is critical to prevent potentially devastating intracranial complications such as meningitis. Options for surgical repair include transmastoid, middle fossa craniotomy, and combined approaches.

The presentation will describe a retrospective case review of 17 consecutive adult patients (18 ears total) who presented with spontaneous CSF otorrhea during an eight-year period to an academic tertiary medical center (The Ohio State University Wexner Medical Center). Seventeen ears underwent the transmastoid approach with repairs performed in a multi-layered fashion. Defects were of various sizes, located mostly in the floor of the middle cranial fossa, but one patient had a concurrent posterior fossa defect. Ossicles were left intact in all cases. Sixteen out of 17 (94 percent) had successful resolution of their CSF leak and did not develop a recurrence. In addition, all but one patient had improvement in their conductive or mixed hearing loss following transmastoid repair, with a mean improvement of 12 dB in the air-bone gap. Closure of the air-bone gap to ≤12 dB occurred in 14 out of 14 (100 percent) of patients.

The objective of this study is to describe the presentation, management, and outcomes of patients who present with spontaneous temporal bone CSF leaks and to determine whether the transmastoid approach to repair is safe and effective. The secondary objective is to determine if improvement in conductive hearing loss is an achievable goal with this approach.

This study adds to the ongoing contemporary debate regarding the advantages and disadvantages of the various surgical approaches to repair of temporal bone CSF leaks,” Dr. Kim said. “Spontaneous CSF leaks have been associated with morbid obesity and idiopathic intracranial hypertension. With the growing obesity epidemic, this may become a more common entity that otolaryngologists will be diagnosing and managing in the near future.”

Recent studies suggest that the transmastoid approach is sufficient for the repair of most spontaneous temporal bone CSF leaks, but hearing outcomes are not well described.

Hearing outcomes following transmastoid repair of temporal bone CSF leaks has really only been described in the setting of chronic ear disease, where the ossicular chain is first removed to address middle ear pathology and later reconstructed,” Dr. Kim said. “This study demonstrates that hearing improvement is feasible following the transmastoid approach to repair of spontaneous CSF leaks without need for ossicular chain disarticulation, even when defects are located anteriorly in the tegmen tympani and tegmen antri.”