The concept of transtympanic injection of fibrin caulk

J. C. Li, J. P. Leonetti and V. Mokarry
Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Ill.

Cerebrospinal fluid otorhinorrhea after basilar skull trauma poses a difficult management problem. When conservative techniques fail, more aggressive neurosurgical and otologic procedures are required to control cerebrospinal fluid leakage. We assessed a less invasive method for the repair of traumatic cerebrospinal fluid fistulas. Thirty-one adult Sprague-Dawley rats were used to develop an animal model for the treatment of cerebrospinal fluid leakage. A fistula was created by removing a thin plate of bone from the superior aspect of the rat bulla. The bulla was then plugged with a transtympanic injection of fibrin caulk. Otoscopic and histologic data were collected at selected intervals. Transtympanic injection of fibrin caulk failed to alter significantly the rate of healing of cerebrospinal fluid fistulas. Coagulum retraction, rapid fibrinolysis, and other reasons for failure are explored.