case_images: PMC11824527_01
case_images: Clinical photograph of the patient's left external auditory canal (EAC) showing a bulge in the posterior EAC (arrow).
case_images: jao-2024-00325f1.jpg
case_images: PMC11824527_01_jao-2024-00325f1.jpg
case_images: f1-jao-2024-00325
case_images: On otoscopic examination, the tympanic membrane was intact, but there was a large collection of fluid pulsating in the roof of the mastoid cavity and middle ear (Fig. 1).
case_images: Pure-tone audiogram showing right (red) normal hearing and left (blue) profound hearing loss.
case_images: jao-2024-00325f2.jpg
case_images: PMC11824527_01_jao-2024-00325f2.jpg
case_images: f2-jao-2024-00325
case_images: Audiometric evaluation revealed left profound hearing loss with normal right-sided hearing (Fig. 2).
case_images: PMC11824527_02
case_images: High-resolution computed tomography (HRCT) imaging of the temporal bone. A: Coronal images of HRCT of temporal bone showing opacification of the left mastoidectomy bowl, middle ear cavity, and widening of the oval window (blue arrow). B: In the corresponding T2-weighted magnetic resonance imaging (MRI) scan, similar fluid signal is seen in continuity from the internal acoustic meatus, vestibule, middle ear to the mastoid, raising the suspicion of cerebrospinal fluid (CSF) in the middle ear and mastoid. Communication between the vestibule and middle ear is shown by the green arrow. C: Axial images of HRCT of temporal bone, showing opacification of mastoid cavity and middle ear, with widening of the oval window and an absent stapes footplate (blue arrow). D: Corresponding T2-weighted MRI scan, showing the area of left oval window defect with absent stapes footplate (green arrow) and similar fluid signal from the vestibule, continuous with middle ear and mastoid, again raising suspicion of likely CSF in the middle ear and mastoid. The same fluid signal is also seen in the Eustachian tube (red arrow).
case_images: jao-2024-00325f3.jpg
case_images: PMC11824527_02_jao-2024-00325f3.jpg
case_images: f3-jao-2024-00325
case_images: During his current admission, high-resolution CT imaging of the temporal bone revealed widened left oval window and absent stapes footplate once again (Fig. 3), with an intact tegmen tympani. T2-weighted magnetic resonance imaging (MRI) of the inner and middle ear demonstrated fluid signals in the middle ear and mastoid, which were similar to the fluid signals in the internal acoustic meatus and vestibule (Fig. 3).
case_images: Intraoperative photograph of the left middle ear showing bulging membrane over the left oval window (white arrow). A small amount of clear fluid was seen leaking from the edge of the bulging membrane, which was suctioned away just before the photo was taken.
case_images: jao-2024-00325f4.jpg
case_images: PMC11824527_02_jao-2024-00325f4.jpg
case_images: f4-jao-2024-00325
case_images: Intraoperatively, CSF was encountered whilst raising the meatal flap and the oval window membrane was bulging with small amount of fluid leaking around it (Fig. 4).