New considerations in the cause of spontaneous cerebrospinal fluid otorrhea.

OBJECTIVE To examine the demographic and radiographic features of patients with spontaneous cerebrospinal fluid otorrhea and to determine whether they display similar characteristics to patients with idiopathic intracranial hypertension. STUDY DESIGN Retrospective case review. SETTING Academic, tertiary referral center. PATIENTS All individuals presenting with spontaneous cerebrospinal fluid otorrhea, diagnosed between 2000 and 2009, undergoing primary surgical repair. INTERVENTIONS All patients underwent surgical repair via a transmastoid, middle fossa, or combined transmastoid-middle fossa approach. MAIN OUTCOME MEASURES Patient demographics such as age, race, sex, height, weight, and body mass index, the presence of a radiographically empty or partially empty sella, and preoperative radiographic and intraoperative surgical findings of the temporal bone. RESULTS Twenty-three patients underwent primary surgical repair for spontaneous cerebrospinal fluid otorrhea. Fifteen patients underwent preoperative magnetic resonance imaging of the head with 12 (80%) demonstrating the presence of an empty or partially empty sella. Mean body mass index of those patients with an empty or partially empty sella was 38.0 kg/m2 compared with 28.5 kg/m2 for those without an empty sella. CONCLUSION Patients with spontaneous cerebrospinal fluid otorrhea are often middle-aged and obese, with females being affected nearly twice as often as males. Empty or partially empty sella was observed in 80% of patients with spontaneous cerebrospinal fluid otorrhea as demonstrated by preoperative magnetic resonance imaging. Patients with spontaneous cerebrospinal fluid otorrhea who display these demographic and radiographic features should be further evaluated for the presence of idiopathic intracranial hypertension.