F.A.O. SQAD

[sag]

This mail may be a little long so I apologise in advance. I have condensed it as much as I can. My daughter-in-law's troubles began in July2009.She started to lose hearing in the right ear for a couple of days only. She then developed this numbness in the right side of her mouth, again for only couple of days. Hearing got worse which meant a visit to G.P. He said there was fluid in the ear but no infection. Prescribed a steroidal nasal spry to try and clear the fluid. No luck! Next visit to an ear clinic where she was told she had Otitis Media and would have to have gromit fitted and was referred to an ENT surgeon. This visit to him told her she did not have the above and had Otosclerosis and reffered to another ENT surgeon who dealt with this. Between these appointments she went for hearing test which found no movement in eardrum and eardrum was bulging (indicating fluid) she had no hearing in this ear by this time.This second ENT surgeon confirmed there was fluid behind the eardrum and and stated it was Otitis Media . He arranged for grommit to be fitted the following week.Two days before this operation was due to take place this chap phoned her to say he had reviewed her notes and asked when was the last time she had had meningitis.Her reply was NEVER. He said symptoms presented at the beginning i.e.numbness in the face, clear fluid behind the eardrum and lack of infection could indicate a CSF leakage into the middle ear. He arranged for sample of fluid to be aspirated from eardrum and this was tested for Beta 2 Transferin. Results were positive. A CT scan should no trauma had caused the leak She was then transferred to a third ENT surgeon who arranged for her to see a neuro-surgeon. He arranged admittion to hospital to have myelogram to see where the leak was, as CT didn't show it clearly. After myelogram it was decided that an operation was was the only option, so a middle fossa craniotomy was perfomed.

[Sqad]

Ah! that all makes sense now:

Right sided numbness of face, right sided deafness, effusion in right ear would alert the surgeon that he was dealing with an intracranial problem. MRI scan today would make the myelogram and C-T un-necessary.

The clue here is right sided numbness of face.

Thank you for a fascinating and unusual case history.

[sag]

Into second page!!! Sorry!
the first question neuro-surgeon asked was, did she ever have a salty taste at the back of the throat, to which she replied she did, but when you have always had it she thought this normal. Operation was performed by neuro-surgeon and the third ENT surgeon. They used a graft from the jaw muscle in the mouth to cover the leak using a larger graft than normal as due to the tegmen bone being transparent They also filled th mastiod and pertous cells with boney wax There was a lot of scarring on the dura around the hole in the bone. The dura burst as they attempted to move it. Immediately after the operation she felt much better, suffering no more headaches and no 'brain fog' as she called it Hearing was 90% better too. Her recovery continues to improve now, thankfully!
I am sure this will all make sense to you one way or another, being who you are. I feel a little humbled! I hope also that you find it all interesting. Is this the rare kind you spoke of by the way?
Nice talking to you. Best regards and enyoy your retirement. I am!!

[Sqad]

Even clearer....the headaches as well.......thank you again for a most interesting case.