Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula – retrospective analysis and review of the literature

Heilen, S; Lang, Carl Philip; Warnecke, Athanasia; Lenarz, Thomas; Ďurišin, Martin

doi:10.1017/s0022215120000948

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Heilen et al treated ninety patients with sudden SHL using exploratory tympanotomy and the sealing of the oval and round windows [ 14 ]; 10 patients (11 percent) were identified with a perilymphatic fistula, corresponding to the results obtained from their review (13.6 percent). In two cases only, the pre- and post-operative audiological evaluation results showed a significant hearing improvement after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In two cases only, the pre- and post-operative audiological evaluation results showed a significant hearing improvement after treatment. They concluded the absence of significant improvement after an exploratory tympanotomy and the sealing of the membranes for patients with a definite perilymphatic fistula presented with SHL [ 14 ]. Our findings were the opposite.…”

Section: Discussionmentioning

confidence: 99%

“…The visual identification of a fluid leak is an objective and observer-dependent finding and may be influenced by a wide variety of factors, such as a Trendelenburg position or forced or sustained inspiration [ 14 ]. Furthermore, it may be attributable to a tiny leak [ 19 ], intermittent leaks, or a spontaneous healing leak.…”

Section: Discussionmentioning

confidence: 99%

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Suspicion and Treatment of Perilymphatic Fistula: A Prospective Clinical Study

Saliba,

Bawazeer,

Belhassen

2024

Audiology Research

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Background: Since the discovery of the perilymphatic fistula (PLF), the diagnosis and treatment remain controversial. If successfully recognized, the PLF is surgically repairable with an obliteration of the fistula site. Successful treatment has a major impact on patient’s quality of life with an improvement in their audiological and vestibular symptoms. Objective: To prospectively investigate patients’ clinical and audiological evolution with PLF suspicion after middle ear exploration and obliteration of the round and oval window. Study Design: Prospective comparative study. Setting: Tertiary care center. Methods: Patients were divided into two groups: Group I consisted of patients where no PLF had been identified intraoperatively at the oval and/or at the round window, and Group II consisted of patients where a fistula had been visualized. Patient assessment was a combination of past medical history, the presence of any risk factors, cochlear and vestibular symptoms, a physical examination, temporal bone imaging, audiograms, and a videonystagmogram (VNG). Results: A total of 98 patients were divided into two groups: 62 in Group I and 36 in Group II. A statistically significant difference regarding gender was observed in Group II (83.3% of males vs. 16.7% of females, p = 0.008). A total of 14 cases (4 and 10 in Groups I and II, respectively) were operated for a recurrent PLF. Fat graft material was used in the majority of their previous surgery; however, no difference was found when comparing fat to other materials. In addition, no statistically significant difference was noted between Groups I and II concerning predisposing factors, imaging, VNG, symptom evolution, or a physical exam before the surgery and at 12 months post-operative. However, both groups showed statistically significant hearing and vestibular improvement. On the other hand, the air conduction (AC) and bone conduction (BC) at each frequency were not statistically different between the two groups before surgery but showed statistically significant improvement at 12 months post-operatively, especially for the BC at the frequencies 250 (p = 0.02), 500 (p = 0.0008), and 1000 Hz (p = 0.04). Conclusions: Whenever you suspect a perilymphatic fistula, do not hesitate to explore middle ear and do window obliterations using a tragal perichondrium material. Our data showed that cochlear and vestibular symptoms improved whether a fistula had been identified or not.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Suspicion and Treatment of Perilymphatic Fistula: A Prospective Clinical Study

Saliba,

Bawazeer,

Belhassen

2024

Audiology Research

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“…Based on our experiences, PLF repair surgery using TEES for idiopathic PLF can be performed without complications under clear visualization and a wide field of view. Heilen et al (12) reported that there is no significant hearing improvement after exploratory tympanotomy with sealing of the round window for patients with SSHL. Prenzler et al (13) reported that exploratory tympanotomy with sealing of the round and oval windows is useful in patients with profound SSHL.…”

Section: Discussionmentioning

confidence: 99%

Clinical course of five patients definitively diagnosed with idiopathic perilymphatic fistula treated with transcanal endoscopic ear surgery

Kubota,

Ito,

Furukawa

et al. 2024

Front. Neurol.

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ObjectivesAn idiopathic perilymphatic fistula (PLF) can be difficult to diagnose because patients present with sudden sensorineural hearing loss (SSHL) and/or vestibular symptoms without any preceding events. In such cases, we currently test for cochlin-tomoprotein (CTP) to confirm the diagnosis of idiopathic PLF because CTP is only detected in the perilymph. In this study, we report the clinical course of five patients definitively diagnosed with idiopathic PLF who underwent PLF repair surgery using transcanal endoscopic ear surgery (TEES).Patients and methodsFive patients were initially treated with intratympanic dexamethasone for SSHL, at which time a CTP test was also performed (preoperative CTP test). Due to refractory hearing loss and/or fluctuating disequilibrium, PLF repair surgery using TEES was performed to seal the oval and round windows using connective tissue and fibrin glue. These patients were diagnosed with definite idiopathic PLF based on pre- or intra-operative CTP test results (negative, < 0.4 ng/mL; intermediate, 0.4–< 0.8 ng/mL; and positive, > 0.8 ng/mL). We evaluated pre- and intra-operative CTP values, intraoperative surgical findings via a magnified endoscopic view, and pre- and post-operative changes in averaged hearing level and vestibular symptoms.ResultsPre- and intra-operative CTP values were positive and intermediate in three patients, positive and negative in one patient, and negative and positive in one patient. None of the patients had intraoperative findings consistent with a fistula between the inner and middle ears or leakage of perilymph. Only two patients showed a slight postoperative recovery in hearing. Four patients complained of disequilibrium preoperatively, of whom two had resolution of disequilibrium postoperatively.ConclusionA positive CTP test confirms PLF in patients without obvious intraoperative findings. The CTP test is considered more sensitive than endoscopic fistula confirmation. We consider that CTP test results are important indicators to decide the surgical indication for idiopathic PLF repair surgery. In our experience with the five cases, two of them showed improvements in both hearing and vestibular symptoms.

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