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Congenital cerebrospinal fluid fistula through the inner ear and meningitis

Published online by Cambridge University Press:  29 June 2007

Peter D. Phelps*
Affiliation:
Royal National Throat, Nose and Ear Hospital, Cape Town, South Africa
David Proops
Affiliation:
Children's HospitalBirmingham, Cape Town, South Africa
Sean Sellars
Affiliation:
Groote Schuur Hospital, Cape Town, South Africa
John Evans
Affiliation:
Hospital for Sick Children, Great Ormond Street, London
Leslie Michaels
Affiliation:
Royal National Throat, Nose and Ear Hospital, Cape Town, South Africa
*
Mr P. D. Phelps, F.R.C.S., Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London WC lX 8DA

Abstract

Congenital deformities of the labyrinth of the inner ear can be associated with a fistulous communication between the intracranial subarachnoid space and the middle ear cavity. We describe seven such cases, six confirmed by high resolution CT and one by postmortem histological section. The seven patients all presented with meningitis although a cerebrospinal fluid fistula was demonstrated at subsequent surgery or postmortem. The lesions were bilateral in three patients, unilateral in three and probably bilateral in the postmortem case although only one temporal bone was obtained. In every case there was a dilated sac instead of the normal two and a half turn cochlea on the affected side and this was confirmed at surgery. The demonstration of the basal cochlear turn is of paramount importance in any deaf child presenting with meningitis. A true Mondini deformity with a normal basal turn and some hearing is not at risk of developing a fistula.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1993

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References

Jackler, R. K., Luxford, W. M., House, W. F. (1987) Congenital malformations of the inner ear: a classification based on embryogenesis. Laryngoscope 97 (Suppl. 40): 214.CrossRefGoogle ScholarPubMed
Phelps, P. D. (1986) Congenital cerebrospinal fluid fistulae of the petrous temporal bone. Clinical Otolaryngology 11: 7992CrossRefGoogle ScholarPubMed
Schuknecht, H. F, Reisser, C. (1988) The morphologic basis for perilymphatic gushers and oozers. Advances in Oro-Rhino- Laryngology 39: 112CrossRefGoogle ScholarPubMed
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