Diagnosis and management of spontaneous CSF otorrhea associated with skull base defects.

OBJECTIVE

This study aimed to characterize spontaneous CSF otorrhea or otorhinorrhea from skull base defects, including its clinical presentation, management outcomes, and causes of recurrence.

METHODS

A retrospective cohort study was performed on 20 patients who underwent surgical repair at Chinese PLA General Hospital between 2009 and 2024.

RESULTS

The cohort was predominantly adult (75%), male, and right-sided. Key presentations were conductive hearing loss (85%), otorrhea (50%), and meningitis (35%). Most defects (85%) involved the middle cranial fossa floor. Initial surgical success was 75%, with recurrence (mean 3.78 months) attributed to inadequate obliteration, recanalization, or missed defects. Notable complications included intracranial hypertension and facial paralysis.

CONCLUSION

Spontaneous CSF otorrhea or otorhinorrhea typically originates from the middle cranial fossa floor in adults. While multi-layered surgical repair is effective, its success can be compromised by technical factors, underscoring the necessity of meticulous preoperative assessment to reduce recurrence.