Clin Exp Otorhinolaryngol.  2012 Jun;5(2):74-80. 10.3342/ceo.2012.5.2.74.

Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

• Park GY
• Byun H
• Moon IJ
• Hong SH
• Cho YS
• Chung WH

• KMID: 2117500
• DOI: http://doi.org/10.3342/ceo.2012.5.2.74

Abstract

OBJECTIVES
Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF.
METHODS
Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively.
RESULTS
All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0+/-14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (< or =40 dB) was obtained in 4 out of 7 cases (57.1%).
CONCLUSION
Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Keyword

Perilymph fistula; Barotraumas; Hearing; Surgery

MeSH Terms

Barotrauma
Dizziness
Fistula
Hearing
Hearing Loss
Hearing Loss, Sensorineural
Humans
Perilymph

Figure

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  Fig. 1 Standard surgical techniques of perilymph fistulas repair. (A) Soft tissue was covered over the oval window and stapes (arrow). (B) Soft tissue was covered over the round window (arrow). (C) Fibrin glue was applied in the middle ear cavity (arrow).

• 

  Fig. 2 Pre- and postoperative audiograms of nine patients (A-I). Preoperatively, down-sloping configurations of audiograms were common. Air bone gap, especially in low frequency (250, 500, and 1,000 Hz), was found in 5 cases (A, B, E-G). Postoperatively, the mean hearing gain was 27.0±14.9 dB, especially at lower frequency and postoperative hearing improved to serviceable level (≤40 dB) in 5 out of 10 cases (A, C, D, F, I). Air bone gap was closed postoperatively.

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  Fig. 3 Various findings during exploratory tympanotomy of patients with suspected perilymph fistulas. (A) Fluid collection in the right round window (RW) niche. (B) Fibrous web around right stapes and oval window (OW). (C) Fibrous web around right RW.

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  Fig. 4 Hearing outcomes analyzed according to the time interval between the trauma and the surgical repair. Two patients (case C and D, empty circle) showed serviceable hearing before the operation.

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  Fig. 5 Pre- and postoperative hearing results. Postoperatively, the mean hearing gain was 27.0±14.9 dB. If surgery was done before 10 days after surgery (case A-F, solid line), serviceable hearing was achieved in 4 out of 7 (57.1%) compared to 1 out of 3 (33.3%) after 10 days after surgery (case G-I, dotted line).

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