The Rottenrow endotracheal tube holder.

Case 3 is a rare congenital abnormality of the inner ear which usually presents as recurrent meningitis. This abnormality is now well documented.4 It should be suspected as a cause of recurrent meningitis in a child who has a sensorineural deafness. The presence of fluid behind the tympanic membrane should make one suspicious and the diagnosis can be confirmed by tomograms of the inner ear. The CSF fistula is from the fundus of the internal auditory canal into the vestibule of the inner ear and from there into the middle ear through a defect in the stapes footplate. The simplest and safest way to close this defect is through the middle ear. A fluid level behind the tympanic membrane is usually due to secretory otitis media. In patients with meningitis or CSF rhinorrhoea, the possibility that the fluid in the middle ear may be CSF should be considered. We thank our neurosurgical colleagues for referring these cases.