Author(s)
Steven D. Curry, MD, MPH
Colin McCorkle, MD
Jonathan L. Hatch, MD
Geoffrey Casazza, MD
Affiliation(s)
Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center;
Abstract:
Objective: Symptoms of temporal encephalocele or cerebrospinal fluid (CSF) leak causing middle ear effusion or otorrhea
can be non-specific and mistaken for other common diagnoses, leading to delays in diagnosis, failed treatments, and a risk of meningitis. This study sought to investigate the association between symptomatology and time to definitive surgical management.
Study Design: Retrospective cohort.
Setting: Single tertiary care academic medical center.
Patients: Adults treated for temporal encephalocele or CSF leak via a middle cranial fossa (MCF) approach. Revision
cases were excluded.
Interventions: Chart review was performed to identify pertinent symptoms at presentation. Four patients who had
symptoms for “several/many years” were coded as having symptoms for 3 years for quantitative analysis. Multivariable
analysis was performed to identify the association between symptoms and time to surgical management.
Main Outcome Measures: Otologic and related symptoms present prior to MCF. Length of time between symptom onset
and surgical treatment.
Results: 35 patients had symptoms present 23.6 ± 25.7 months (range: 1 month to 12 years) prior to surgery. The most
common symptoms were subjective hearing loss in the affected ear (77%) and aural fullness (74.3%). Otorrhea was present in 57.1%, and 42.9% had a history of myringotomy with or without tube insertion. Meningitis occurred in 5 patients (14.3%). Only the absence of otalgia was statistically significantly associated with decreased time between symptoms onset and surgery (p = 0.03).
Conclusions: Encephalocele and CSF leak were most commonly associated with aural fullness and hearing loss. Medical
treatment for presumed Eustachian tube dysfunction or myringotomy and subsequent CSF otorrhea were commonly
observed. Patients had symptoms for an average of about 2 years prior to surgical management.
Professional Practice Gap & Educational Need: Temporal encephalocele or middle ear effusion due to CSF leak can
present with non-specific otologic symptoms including aural fullness and conductive hearing loss. This can result in a
lengthy period of time before the correct diagnosis is made, and having CSF otorrhea puts the patient at risk of ascending
infection and meningitis.
Learning
Objective: To understand the presentation of temporal encephalocele of CSF leak and the need for consideration in the differential diagnosis of common otologic symptoms.
Desired
Result: Increased recognition of encephalocele and CSF leak in the differential diagnosis of common symptoms
including aural fullness, conductive hearing loss, and middle ear effusion, as well as appreciation of the need for
improvement in diagnosis of these entities to avoid unnecessary treatment delays and added risks to patients.
Level of Evidence: Level IV
Indicate IRB or IACUC: Approved, UNMC IRB #412-19-EX.