Attic Cholesteatoma with CSF Otorrhoea

An attic cholesteatoma is defined as an epidermoid cyst found in the attic. This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma. CSF otorrhea occurs only if a perforation in the eardrum or a defect in the external ear canal is present. This is often the case when the leakage results from trauma or previous ear surgery. However, in the absence of such a defect, the fluid flows down the eustachian tube and manifests as a clear rhinorrhea. In this situation, it must be differentiated from a spinal fluid leak from other areas of the skull base, such as the sinuses. The reverse is also important to remember; just because the leak is through the nose does not mean that an otologic source is not a possibility.