EpistemisOtoliquorrhea
Specialty: Otolaryngology.
Why it occurs
- Fracture of the base of the skull with fracture of the temporal petrous bone and disruption of the adjacent dura mater
- Congenital defects in the middle cranial fossa or posterior cranial fossa that compromise the roof of the eardrum
- Chronic bone erosion due to extensive untreated cholesteatoma that destroys the tegmen tympani
- Post-surgical complication after otoneurosurgical approaches to the skull base
Initial workup
Collection of the secretion for qualitative determination of Beta-2 transferrin or Beta-trace protein (highly specific markers of CSF), high-resolution CT of petrous bones with millimeter sections, cisterno-CT or cisterno-MRI to precisely identify the exact location of the dural and bone defect.
red flags
Continuous discharge of unilateral clear watery fluid ("rock water") that increases when performing Valsalva maneuvers, persistent neck stiffness, high fever of acute onset, severe photophobia with intense holocranial headache, or positive meningeal signs of Kerning or Brudzinski.
Standard management
- Prophylactic vaccination against pneumococcus and meningococcus to reduce the risk of secondary bacterial meningitis
- Broad-spectrum antibiotics with good penetration of the blood-brain barrier if there is suspicion of active infection, such as ceftriaxone — 2 g intravenously every 12 hours
- Avoid the use of local ear drops that can introduce germs to the subarachnoid space
- Osmotic laxatives such as lactulose (15 ml every 12 hours orally to avoid straining at defecation that increases intracranial pressure).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4