Spontaneous Cerebrospinal Fluid Otorrhea Secondary to Tegmen Tympani Dehiscence: A Case Report and Literature Review.

Spontaneous cerebrospinal fluid (CSF) otorrhea is an uncommon but increasingly recognized condition, particularly in older adults. It most often results from temporal bone defects, such as tegmen tympani dehiscence, which establish abnormal communication between the subarachnoid space and the middle ear or mastoid air cells. Clinical manifestations of CSF otorrhea may range from subtle conductive hearing loss and middle ear effusion to life-threatening recurrent meningitis. High-resolution computed tomography (HRCT) is essential for diagnosis and surgical planning. We are presenting a 66-year-old woman with a history of conservatively managed subdural hematoma, who presented with persistent, clear otorrhea from the left ear. Beta-2 transferrin testing confirmed the presence of CSF. HRCT of the temporal bones demonstrated bilateral tegmen tympani thinning with focal dehiscence, most pronounced on the left, along with a small encephalocele extending into the left mastoid air cells and associated mastoid opacification. Bilateral superior semicircular canal dehiscence was also noted. The patient underwent a left-sided middle cranial fossa approach, which confirmed focal tegmen dehiscence with exposed dura. Postoperatively, the otorrhea resolved, and no intracranial complications occurred. Spontaneous CSF otorrhea secondary to tegmen tympani dehiscence should be considered in older patients presenting with unexplained persistent otorrhea or middle ear effusion. HRCT provides crucial diagnostic information, while the middle cranial fossa approach enables direct repair and durable outcomes. Early recognition and surgical intervention are vital to prevent recurrence and serious complications such as meningitis or hearing loss.