{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:14:33Z","timestamp":1777562073230,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ear Nose Throat J"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To review the literature on Hyrtl fissure (HF) and contribute our experience with a 2-year old who developed cerebrospinal fluid (CSF) otorrhea during routine tympanostomy tube placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Data Sources:<\/jats:italic>\n                      Pubmed and Google Scholar searches were conducted of articles in the English language literature from all time periods using the words Hyrtl, Hyrtl\u2019s fissure, HF, and tympanomeningeal fissure.\n                      <jats:italic toggle=\"yes\">Study Selection:<\/jats:italic>\n                      All relevant articles were reviewed to identify cases of HF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Data Extraction:<\/jats:italic>\n                      Nineteen cases, including ours, are described. Patient characteristics, method(s) of diagnosis and repair, and outcomes are reported. Computed tomography and intraoperative endoscopic images from our case are included. Presentation is more common in children (66.7% of cases where age was stated, n = 10) than in adults (33.3%, n = 5), and is most commonly unilateral (89.5%, n = 17). Cerebrospinal fluid otorrhea was the most common presentation. Six were discovered after tympanostomy tube placements while 3 were identified during cochlear implant work-up or after device failure. Surgical approaches described include endaural, transcanal, retrosigmoid, postauricular, and posterior fossa endoscopic. Multiple materials including bone wax, bone pate, fascia, muscle, and tissue sealant have been used. Our case describes an endoscopic repair in a child, which was successful at a 2-year follow-up.\n                      <jats:italic toggle=\"yes\">Data Synthesis:<\/jats:italic>\n                      The small number of cases limits the utility of statistical analysis (n = 19).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hyrtl fissure is a rare but important entity that may be discovered when routine procedures have unexpected results. Hyrtl fissure should be included in the differential diagnosis when there is persistent clear otorrhea after a tympanostomy tube, cochlear implant misinsertion, meningitis, or unexplained middle ear effusion in an adult.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01455613211039045","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T05:36:46Z","timestamp":1667885806000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebrospinal Fluid Otorrhea After a Routine Tympanostomy Tube Placement: A Review of the Literature on Hyrtl Fissure"],"prefix":"10.1177","volume":"104","author":[{"given":"Rebecca M.","family":"Oney","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Del R.","family":"Sloneker","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Womack Army Medical Center, Fort Bragg, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0436-3207","authenticated-orcid":false,"given":"Ashlie G.","family":"Bloom","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Avillion","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James V.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Idaho Ear Clinic, Boise, ID, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian S.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,11,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25366"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2008.04.005"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215119000203"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27208"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1058978"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200207000-00015"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otot.2013.11.010"},{"issue":"4","key":"e_1_3_2_9_2","first-page":"963","article-title":"Hyrtl\u2019s fissure: a case of spontaneous cerebrospinal fluid otorrhea","volume":"26","author":"J\u00e9goux F","year":"2005","unstructured":"J\u00e9goux F, Malard O, Gayet-Dalacroix M, Bordure P, Legent F, Beauvillain de Montreuil C. Hyrtl\u2019s fissure: a case of spontaneous cerebrospinal fluid otorrhea. Am J Neuroradiol. 2005;26(4):963\u2013966.","journal-title":"Am J Neuroradiol"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215115001206"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1549220"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2011.08.007"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348947908800311"},{"issue":"01","key":"e_1_3_2_14_2","first-page":"S1","article-title":"Special considerations in pediatric neurotologic skull base surgery","volume":"78","author":"Sappington JM","year":"2017","unstructured":"Sappington JM, Culicchia F, Mehta R, Arriaga MA. Special considerations in pediatric neurotologic skull base surgery. J Neurol Surg B. 2017;78(S 01):S1\u2013S156.","journal-title":"J Neurol Surg B"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1986.tb00112.x"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/019459989010200609"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198005001-00001"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1249249"},{"key":"e_1_3_2_19_2","volume-title":"Vergleichend-anatomische Untersuchungen \u00fcber das innere Geh\u00f6rorgan des Menschen und der S\u00e4ugethiere","author":"Hyrtl J","year":"1845","unstructured":"Hyrtl J. Vergleichend-anatomische Untersuchungen \u00fcber das innere Geh\u00f6rorgan des Menschen und der S\u00e4ugethiere. 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