A Case of Otorrhœa Due to Parotid Fistula

A CHRONIC and Jntractable discharge from a fenestration cavity is unfortunately a common occurrence. In a series of 500 cases Howard House of Los Angeles found that some 20 per cent, had a persistent and troublesome otorrhoea following fenestration. It is generally accepted that the discharge is usually caused by a Jailure of the mastoid portion of the cavity to epithelialize resulting in the formation of indolent granulation tissue and infection of the mastoid air-cells. The case which I am about to present is unusual and of considerable interest in that otorrhoea after fenestration was found to arise from a parotid fistula leading into the anterior part of the cavity. The patient is a doctor's wife, aged 37, who has bilateral otosclerosis and had some 60 decibels of hearing loss in each ear. Jn 1949, she had a right endaural fenestration operation performed at another hospital and this gave an excellent hearing result and a jdry ear, but unfortunately there was a serious deterioration of hearing during the course of a subsequent pregnancy in 1951. In 1956, she underwent a jfenestration on the left side, at the same hospital, and again the endaural approach was used. The operation on this second ear was also successful in that she obtained an excellent improvement of hearing which has been maintained up to the present time. This left fenestration_cayity, however, did not dry up rapidly as the right had done, despite frequent and energetic treatment with antibiotic ear drops, cautery of granulations and aural toilet. In February, 1957, that is, five months after her left fenestration, the patient made the rather astonishing observation that her left ear discharged much more at meal times. She said that it ran profusely at lunch time and to a lesser degree at supper, but denied that there was any discharge at breakfast; further questioning, however, revealed that she did not normally take breakfast! Thinking that there might be a parotid fistula, the husband was sent out for an_orange and when the patient was given this to suck one was rewarded by seeing a free flow from the left ear of some 5 ccs. of watery