Repair Spontaneous CSF Leaks Firmly to Avoid Recurrence

Initially, I typically place a lumbar drain for three days following repair in patients with evidence of elevated intracranial pressure, he said. I will use a more permanent shunt in cases where the initial repair failed.

Dr. Kingdom agreed with Dr. Palmer that bone or other rigid structures should be used in larger defects. However, he noted that experts have not agreed on whether a leak size of 5 mm or 10 mm should be the threshold at which the use of bone should be considered. Dr. Kingdom uses biologic glues and adhesives over the bone, and, like Dr. Palmer, uses autologous soft tissue as the final layer, such as mucus membrane from the nose, fat, or fascia.

News & Notes

OTC Earwax Softener May Be Harmful

An over-the-counter (OTC) earwax softener may cause inflammation to the eardrum and inner ear, according to a recent study.

Researchers from McGill University in Montreal, led by Sam Joseph Daniel, MD, MSc, assessed the effect of ototopic triethanolamine polypeptide oleate condensate 10% (Cerumenex, an OTC earwax softener) on hearing in five chinchillas in a prospective, randomized, controlled trial. Tympanostomy tubes were inserted in the chinchillas, and hearing was assessed with distortion product otoacoustic emissions (DPOAE) between 1 and 9 kHz prior to application and at days 1, 4, 30, and 100 postototopic application of Cerumenex. Postmortem scanning electron microscopy was performed to assess cochlear hair cells.

Researchers found a reduction in the mean DPOAE signal in the treated ears from the first day after the treatment and throughout the study. They also found swelling, crusting, and fluid in four of the five Cerumenex-treated ears, and post-treatment facial paralysis in one case. Electron microscopy revealed damage to the outer and inner hair cells of the treated ears.

The researchers, who published their results in the December 2007 issue of Laryngoscope, conclude that further studies on the efficacy and safety of Cerumenex and other cerumenolytics on both animal and human hearing be conducted. In the meantime, the researchers recommend that caution be observed when prescribing these products and that their use without medical prescription be discouraged.

©2008 The Triological Society