Surgical management of perilymphatic fistulas: Diagnosis and treatment of perilymph fistulas without hearing loss. The decision to consider a PLF repair is guided by a positive fistula test or an immediate onset of Meniere’s disease symptom complex after head or ear trauma. Platform pressure test in identificaztion of perilymphatic fistula. Sudden deafness and labyrinthine window ruptures.
This report provides a literature review to help put this series’ results into perspective. In two patients intraoperative EcochG with suction demonstrated a nonvisible window PLF, which the office valsalva test had predicted [ 73 ]. The report that intravenous fluoresceine assisted the intraoperative detection of PLF [ 48 ] aroused the hope that this could be the ideal simple technique, soon dispelled by two animal studies [ 49 , 50 ] showing fluorescence around the round and oval window niches from fluid transudates, with only weak or nonfluorescence of perilymph. The theory proposes that a force up an abnormally patent cochlear aqueduct could rupture the basilar membrane and Reisner’s membrane into the scala vestibuli, and conceivably injure the utricle, saccule, the semicircular canal system, the round window membrane, or the annular ligament of the stapes. A early attempt on the use of ENG testing for eliciting nystagmus by canal pressure with a pneumatic otoscope Hennerbert’s sign predicted the presence of PLF in some patients [ 74 ]. Myth of spontaneous perilymph fistula.
There are already excellent large reviews on the topic [ 1 — 3 ]. Because only one PLF was seen they concluded that endoscopy may be of a limited value for diagnosing that condition. Perilymphatic fistula following airbag trauma.
Perilymphatic fistula and Meniere’s disease. Clinical series and literature review.
Mainly because of financial constraints there are now only three [ 83 ]. Fluorescein as an easy, low-cost, indirect, or reverse intraoperative marker to rule out perilymph versus local injection.
These findings were the impetus for Kohut’s temporal bone studies on patients who might have had a PLF [ 29 ]. The possible relevance of the Tullio phenomenon to PLF diagnosis liherature been considered [ 79 — rveiew ]. They commented that the diagnosis is difficult because of the similarity of these symptoms to those of endolymphatic hydrops, a commonly repeated notion that persists to this day.
In Goodlhill’s paper [ 22 ] on sudden sensorineural deafness diagnosed as having PLF two were children with a history of exertion. In that regard a change on the intraoperative EcochG [ 71 — 73 ] is the most unequivocal test that a window fistula is present, but it requires special equipment and is unavailable to most. Claims for clinical balance tests demonstrating a specific PLF sign unrelated to inner ear hypofunction [ 82 ] require objective verification.
Received Apr 9; Accepted Jun Endoscopic diagnosis of idiopathic perilymphatic fistula. The etiology is either congenital or acquired.
Perilymph Fistula: Fifty Years of Controversy
The resolution of temporal bone imaging by computed tomography CT and by magnetic resonance imaging MRI is improving. Cochlin-tomoprotein CTP detection test identifies traumatic perilymph fistula due to penetrating middle ear injury. Annals of Otology, Rhinology and Laryngology.
A recurring claim is that individuals with a PLF have endolympahtic hydrops in the affected ear [ 9 ], and that this is the reason for their vestibular symptoms, requires some scrutiny.
It then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause of PLF. Archives of Physical Medicine and Rehabilitation. Validity of spontaneous lerilymph fistula.
Congenital and acquired perilymph fistula: review of the literature.
The surgical treatment consists in placing literatire graft of temporalis fascia or tragal perichondrium and it usually results in a significant improvement of vestibular symptoms and sometimes of literagure hearing function as well. False positives may have been due to a startle reflex. The Barany Society has sought to refine the definition of common vestibular symptoms [ 91 ].
The most common symptoms of a PLF are vestibular, but a confusing range of unverified terms has been used and needs to be clarified. In animal models of PLF caused by removing or breaching the round window membrane in guinea pigs and cats [ 64 — 67 ] histology and auditory brainstem hearing thresholds suggest that PLFs can heal, that there may be no long-term hearing loss, and sometimes cochlear hydrops is observed.
Gibson has also used the intraoperative EcochG as a method of both proving and disproving the presence of a window fistula.
When the cause was blunt head trauma the fistula periljmph always at the oval window. Author information Article notes Copyright and License information Disclaimer. Zur dritten Otosklerose-Hypothese Otto Mayers. The most commonly employed chemical test to distinguish perilymph from other fluids has been beta-transferrin, which is in perilymph and cerebrospinal fluid CSF but not plasma.
Hearing loss was a less common feature. Similarly claims that PLF patients have positionally-induced nystagmus may be explained by coincidental benign positional vertigo. Many hold strong views on its existence or otherwise, the symptoms it might cause, the tests which might predict it, the reliability of what is described on exploration, and the effect of repair on symptoms. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
As far as therapy is concerned, surgical treatment can be performed and the perilymph fistula thus revuew one of the few litersture of sensorineural hearing loss that can be treated surgically.
The commonest symptom combination was vestibular and auditory.