In this series, patients with spontaneous CSF otorrhea were more likely to be severely and morbidly obese than were patients with nonspontaneous otorrhea. OSA was also more common in these patients. The findings from this study support an association between obesity and spontaneous CSF leaks. Patients presenting with spontaneous CSF otorrhea should therefore be screened for OSA and signs of increased intracranial pressure.

Contemporary otomicrosurgical techniques have made total removal of acoustic tumor with preservation of the seventh and sometimes the eighth cranial nerves possible. The four approaches currently used in acoustic tumor surgery are the middle cranial fossa, the translabyrinthine, the suboccipital, and the combined translabyrinthine-suboccipital. This review examines the surgical results in the removal of more than 600 acoustic tumors and outlines a rationale for the choice of approach. Tumor size on computed tomographic scan and auditory reserve establish the parameters used in planning the surgical procedure. The translabyrinthine exposure is used most frequently followed by the combined translabyrinthine-suboccipital. The middle fossa and suboccipital approaches are used when preservation of hearing is attempted. Total removal of tumor was accomplished in more than 99% of patients with a mortality rate of less than 1%. Anatomic preservation of the facial nerve, which is directly related to tumor size, was achieved in more than 80% of patients. Preservation of hearing is unlikely when the tumor is larger than 2 cm; anatomic preservation of the cochlear nerve was successful in 73% of hearing preservation procedures.

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Patients with localized damage to the taste system often experience no subjective change in real-world taste experience. In an effort to understand this, eight patients who recently underwent acoustic neuroma removal were evaluated for taste loss. Localized taste testing showed that taste intensities decreased in the distribution of cranial nerve VII ipsilateral to tumor removal as expected, but asymmetries occurred for IX. Intensities were greater on the side contralateral to the tumor removal. In addition, palatal taste, also thought to be mediated by VII, was not totally abolished. It is concluded that cranial nerve IX is normally inhibited by cranial nerve VII in the taste network. When VII is damaged, this inhibition is abolished. This release of inhibition serves as a compensation mechanism that preserves normal taste experience.

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