There was history of meningitis in 20% of these cases. All identifiable defects were located to the middle fossa plate, distant to the labyrinth. We review in this article the records of our 7 previously reported cases and 5 previously unreported cases of spontaneous CSF leakage. Preoperative defect localization is discussed, with emphasis on the efficacy of intrathecal contrast studies. Surgical approach for repair is then related to preoperative hearing levels and defect characteristics.

Cerebrospinal fluid rhinorrhea is the result of transdural communication between the subarachnoid space and the skull base. A transdural fistula may originate from the anterior, middle, or posterior cranial compartments. All skull-base sites of leakage potentially lead to the nasal cavity. Recurrent meningitis is commonly associated with such a direct source of bacterial contamination. Organisms associated with recurrent meningitis secondary to cerebrospinal fluid leaks are commonly found in the upper respiratory tract. We report a case of recurrent meningitis in a 5-year-old girl that highlights the problem of cerebrospinal fluid rhinorrhea, and we discuss etiology, current diagnostic techniques, and surgical management.

Jugular bulb anatomy is variable. A "high-riding" bulb extending into the tympanic cavity is a well-described anomaly. Petrous jugular malposition (diverticulum) (PJMD), however, is rare. The relationship between PJMD and clinical symptoms is questionable because the differentiation between PJMD as an anatomic variant and pathologic process is unproved. A literature review reveals 14 previously documented cases. We report an additional four cases. Diagnostic and management dilemmas are discussed, with the importance of high-resolution CT stressed.

An association of round window atresia and congenital stapes fixation is apparent. The mechanism of the conductive hearing loss following stapedectomy remains poorly understood. Computed tomography imaging and surgical confirmation are probably both necessary to establish the diagnosis of round window atresia.

In the medical evaluation, rehabilitation, and education of the hearing impaired, the first line of defense is the high-risk factor screening for sensorineural damage of all neonates. The most efficacious means of neonatal screening for those factors affecting sensorineural hearing damage is the employment of a high-risk registry. Based on a retrospective study of 109 children with sensorineural loss, high-risk factors and how improved use of the high-risk registry permits earlier detection (and statistically more successful rehabilitation) for such auditory-impaired children are discussed. The importance of pediatric screening of all neonates for hearing loss, in addition to use of the high-risk registry, is evidenced by the fact that only 46% of the children retrospectively identified in our study would have routinely appeared among the high-risk infants were the registry used alone.