title: Cerebrospinal fluid otorrhoea following grommet insertion: management using a multi-layered graft technique and an important lesson revisited.
abstract: BACKGROUND
  A spontaneous cerebrospinal fluid leak can sometimes only become apparent following grommet insertion and usually represents dehiscence of the tegmen tympani, which is an uncommon condition.
  
  
  OBJECTIVE
  This report aimed to reaffirm the importance of recognising this unusual presentation and outline management options.
  
  
  METHODS
  A 63-year-old man with conductive hearing loss and type B (flat) tympanometry underwent grommet insertion into his left ear, which resulted in cerebrospinal fluid otorrhoea. A defect of the tegmen tympani was found. This was successfully repaired via a transmastoid approach using a multi-layered grafting technique.
  
  
  CONCLUSIONS
  Dehiscence of the tegmen tympani is uncommon and may only come to light following grommet insertion, which may be problematic for the uninformed otolaryngologist. Education is important to ensure early recognition and appropriate management.
authors.affiliation: Department of Otolaryngology, Ipswich Hospital, Ipswich, UK.
authors.forename: S
authors.initials: S
authors.lastname: Patil
authors.forename: A
authors.initials: A
authors.lastname: Trinidade
authors.forename: M
authors.initials: M
authors.lastname: Yung
authors.forename: N
authors.initials: N
authors.lastname: Donnelly
mesh_terms: D000158:Acoustic Impedance Tests; D002558:Cerebrospinal Fluid Otorrhea / Q000150:complications / Q000209:etiology / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000009:adverse effects*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps; D018058:Tympanic Membrane Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*