title: Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair.
abstract: OBJECTIVE
  To determine whether the transmastoid approach to repair of spontaneous temporal bone cerebrospinal fluid (CSF) leak is safe and effective and if improvement in conductive hearing loss is an achievable goal with this approach.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Fifteen consecutive patients (16 ears) presented with spontaneous temporal bone CSF leaks over a 6-year period. Clinical data, imaging, audiometry, operative reports, and postoperative course were reviewed.
  
  
  RESULTS
  Median age was 59.5 years. Mean body mass index was 40.7 kg/m2. All presented with chronic otorrhea after tympanostomy tube placement and conductive/mixed hearing loss. The mean preoperative air-bone gap was 19 dB. A transmastoid approach alone was used in 15 cases; 1 underwent middle fossa craniotomy. Most defects were located in the tegmen mastoideum and tympani. All repairs were multilayered, typically using autologous mastoid bone, temporalis fascia, and tissue sealant. Primary repair was successful in 15 cases; 1 patient with persistent postoperative otorrhea subsequently underwent middle fossa craniotomy, but no frank leakage was found. No serious complications were encountered. Following transmastoid repair, postoperative audiograms were available for 14 patients. The mean improvement in air-bone gap was 12 dB. Closure of the air-bone gap to ≤12 dB occurred in 100% of cases.
  
  
  CONCLUSIONS
  The transmastoid approach to repair of spontaneous temporal bone CSF leak is highly successful. Furthermore, patients in this series had excellent hearing results with closure of their air-bone gap to ≤12 dB, which has not been previously described.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Kim
authors.forename: Clayton Ellis
authors.initials: CE
authors.lastname: Wisely
authors.forename: Edward E
authors.initials: EE
authors.lastname: Dodson
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D006314:Hearing Loss, Conductive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013701:Temporal Bone; D016896:Treatment Outcome
keywords: cerebrospinal fluid otorrhea; idiopathic intracranial hypertension; spontaneous cerebrospinal fluid leak; temporal bone encephalocele; temporal bone meningoencephalocele; transmastoid approach