Rare Cases of Cerebrospinal Fluid Oto-Rhinorrhoea in Patients with Congenital Inner Ear Malformations

Priyanshi Agarwal; W V B S Ramalingam; A V Ramesh; Neha Sood; Jameel Manzoor; Kanika Sekhri

doi:10.1007/s12070-023-04098-1

Rare Cases of Cerebrospinal Fluid Oto-Rhinorrhoea in Patients with Congenital Inner Ear Malformations

Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):4101-4105. doi: 10.1007/s12070-023-04098-1. Epub 2023 Jul 21.

Authors

Priyanshi Agarwal¹, W V B S Ramalingam¹, A V Ramesh¹, Neha Sood¹, Jameel Manzoor¹, Kanika Sekhri²

Affiliations

¹ Department of ENT and Head and Neck Surgery, BLK Super Speciality Hospital, New Delhi, India.
² Department of Radiology, BLK Super Speciality Hospital, New Delhi, India.

PMID: 37974848
PMCID: PMC10645699 (available on 2024-12-01)
DOI: 10.1007/s12070-023-04098-1

Abstract

Spontaneous cerebrospinal fluid (CSF) oto-rhinorrhoea is rare and may develop secondary to inner ear malformation. Any child discharging watery fluid through nose or ear spontaneously in a head dependent position should be a high index of suspicion of CSF leak. If watery rhinorrhoea is present then apart from biochemical analysis of fluid discharge to confirm it to be CSF, computed tomography of paranasal sinuses and temporal bone should be carried out to differentiate between CSF oto-rhinorrhoea and CSF rhinorrhoea. Congenital deformities of the inner ear can be associated with meningitis and varying degrees of hearing loss. Here we describe two cases, one of CSF oto-rhinorrhea in a 1 year old child who presented with spontaneous watery rhinorrhoea following violent projectile vomiting of 1 month duration. On evaluation, child was found to have CSF oto-rhinorrhoea with right Mondini deformity and profound hearing loss on right side. 2nd case was of 12 years old male with profound hearing loss right ear and recurrent episodes of meningitis diagnosed as common cavity malformation of inner ear. Both children underwent closure of CSF leak from oval window successfully. There was no recurrence after more than 1 year of follow up. Congenital inner ear malformations are an important cause of recurrent meningitis in children and require a high index of suspicion for diagnosis. Thorough clinical evaluation and radiological study is suggested in all cases of CSF oto-rhinorrhoea for the identification inner ear malformation and management of CSF oto-rhinorrhoea. Patients who receive an accurate and early diagnosis can avoid severe complications and have a good prognosis.

Keywords: Cerebrospinal fluid (CSF) oto-rhinorrhoea; IEM or inner ear malformation; Recurrent meningitis.

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