A 35-year-old patient with known cholesteatoma develops sudden-onset profuse clear watery discharge from the ear after straining. The discharge tests positive for beta-2 transferrin. Which complication has most likely occurred?

• A Labyrinthine fistula with perilymph leak
• B Tegmen erosion with cerebrospinal fluid otorrhoea ✓
• C Sigmoid sinus thrombophlebitis with serous exudate
• D Sudden sensorineural hearing loss with endolymph leak

Explanation

Beta-2 transferrin is a uniquely specific marker present only in CSF, perilymph, and aqueous humour — not in blood, serum, or mucus. Profuse clear watery otorrhoea with positive beta-2 transferrin confirms CSF otorrhoea, indicating that the cholesteatoma has eroded the tegmen tympani or tegmen mastoideus, creating a communication between the middle cranial fossa and the ear. Perilymph leaks are typically scant. This is a surgical emergency requiring prompt repair to prevent meningitis.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.