Recurrent attacks of meningitis occurring independent of a systemic bacterial infection should be considered as a cerebrospinal leak either otorrhea or rhinorrhea. Three cases each with a different cause were diagnosed chiefly on the basis of the history and a bulging noninflammatory eardrum. Subsequent use of fluorescein intrathecally not only helped to confirm the diagnosis but was very useful at surgery in locating the leak in the dura of the oval window of the ear.
Many materials have been used but autogenous temporal fascia or fascia lata seemed to be most effective in these cases. The sandwiching of the dura between two pieces of fascia is not only realistic but was found to be very effective. One piece of fascia between the arachnoid and dura and another between the dura and bone give a tight seal.