Our Experience in the Management of CSF Otorrhea: A Transmastoid Approach with Middle Ear Cavity Obliteration and a Middle Cranial Fossa Approach

In this report, we present two cases of patients with cerebrospinal fluid (CSF) otorrhea who underwent surgical repair through either a transmastoid or middle cranial fossa approach. In our first case, a 34-year-old male after head trauma with conductive hearing loss and a House-Brackmann grade 2 facial palsy was found to have a soft tissue mass protruding through his right tympanic membrane. Radiological examination revealed a wide tegmen tympani defect. He underwent surgery via a transmastoid approach with repair of the defect and blind sac closure of the external auditory canal after middle ear cavity obliteration. Our second case involved a 50-year-old female who had developed chronic clear otorrhea following tympanostomy tube placement. Radiological evaluation revealed a tegmen tympani defect and CSF fistula. She underwent a middle cranial fossa approach in which a multilayer closure technique was performed. These two cases illustrate that the type of surgical approach for the CSF otorrhea repair depends on the location and size of the defect and hearing status. We recommend a multilayer closure to ensure proper resolution of the defect.