Mount Sinai neurotologists routinely work with colleagues from neurosurgery to repair cerebrospinal fluid (CSF), or brain fluid leaks from the ear. Symptoms of CSF leak include clear fluid leaking from the ear or nose, especially while bending forward. Oftentimes there is fluid chronically behind the ear drum and when a tube is placed in the doctor’s office, the fluid continues to drain and does not stop. In many cases the reason for a brain fluid leak is high pressure inside the head that gradually erodes the bone of the ear over time. Eventually, fluid starts to leak or a small area of the brain herniates through a bony hole, forming an encephalocele. In patients without high pressure, a CSF leak or encephalocele may be due to prior surgery, trauma, a tumor, or cholesteatoma. Surgery is the mainstay of treatment for this issue, as a large percentage of people who do not fix it may develop meningitis, a potentially deadly infection.
We generally repair a temporal bone CSF leak one of three ways—through the mastoid (bone behind the ear), through a middle fossa craniotomy (a bony window on top of the ear) or a combination approach. Much like a roofer fixes a roof, we patch the hole from above and below using the patient’s own tissue. The success rate for repair is very high, and patients may be in the hospital for one or a few days.
George Wanna, MD, FACS Chair of Otolaryngology – Head and Neck Surgery New York Eye and Ear Infirmary of Mount Sinai and Mount Sinai Beth Israel Chief, Division of Otology-Neurotology Mount Sinai Health System Professor of Otolaryngology, and Neurosurgery Icahn School of Medicine at Mount Sinai
Maura K. Cosetti, MD Director, Ear Institute at New York Eye and Ear Infirmary (NYEE) of Mount Sinai Director, Cochlear Implant Program Mount Sinai Health System
Enrique R. Perez, MD, MBA Director of Otology-Neurotology The Mount Sinai Hospital Assistant Professor, Otolaryngology Mount Sinai Health System
Zachary G. Schwam, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Division of Otology-Neurotology, Lateral Skull Base Surgery Mount Sinai Health System
