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Introduction

The most common causes of CSF otorrhea are injuries of the temporal bone, chronic ear disease, tumor removal, ear surgery or congenital ear anomaly (Mondini deformations, malformations of the round and oval window, persistent Hyrtl’s fissure, enlarged vestibular aqueduct, arachnoid granulations) . CSF leak to the tympanic cavity may cause significant difficulties in the diagnostics . Thus, examination should include a detailed history and analysis of clinical symptoms, CT and/or MR imaging and biochemical tests of the middle ear fluid for the presence of β2-transferrin . Most CSF leaks close spontaneously; some require surgical procedure. The first stage of treatment involves reduction of the intracranial pressure by maintaining a patient in a horizontal position with head elevated (at 30° angle), bowel movement regulation, lumbar drainage and pharmacotherapy. Repeated lumbar drainage has been used in an attempt to lower intracranial pressure and remove CSF at a rate equal to its production. A variety of possible surgical approaches exist, including tympanotomy, middle fossa, retrosigmoidal or translabyrinthal . In order to perform obliteration of the fistula together with the tympanic cavity in case of CSF leak to the middle ear, it is advisable to choose a combination of at least two different components, choosing from fat, muscle tissue, fragments of cartilage, bone or a piece of fascia with tissue adhesive . Lateral petrosectomy with muscle obliteration of the fistulae and total obliteration cavity is the last resort treatment since it entails serious consequences (damage to the facial nerve, unilateral deafness, problems with cochlear implantation). We describe three children aged 4, 5 and 15 years with spontaneous otorrhea, who were treated in our department. No bioethical approval was necessary for this paper.