Combined Microscopic-Endoscopic Approach for Recurrent Otoliquorrhea

By June 7, 2019

Langer, Joerg1; Pethe, Wolfram1
1 ENT Department, AMEOS Clinic Halberstadt; Germany.

We report the case of a 57 years old man suffering from recurrent otoliquorrhea for more than 5 years. Initially he underwent a neurosurgical treatment for covering the tegmen tympani with tissue over a subtemporal approach.

After appr. 1 year the otoliquorrhea appeared again and an aditional neurosurgical treatment was done. After a period of appr. 1 year the otoliquorrhea appeared again.

MRI and CT scans did not show any CSF fistula in the area of the roof of the middle ear. We planned a subtotal petrosectomy and obliteration of the middle ear. Additionaly an VSB-Implantation was decided.

During the neurootological surgery the possible region of otoliquorrhea could detected anterior and cranial of the malleolus.
After removing the incus and the mallolus the CSF fistula could be detected by using an 30° endoscope.

With combined using of endoscope and microscope an effecitive closure of the fistula was possible (EES II).
Using endoscopes in cases of CSF fistula in the middle ear region seems to be a succesful instrument for fistula closure instead of neurosurgical approaches.