Perilymphatic fistula: Surgical experience in the united states

Abstract

One survey sent to 6953 individual otolaryngologic practices and 106 departments of otolaryngology at teaching hospitals in the United States, and a more limited survey of 75 patients operated on for perilymphatic fistula (PLF) at the House Ear Institute, addressed aspects of managing PLF: surgical incidence, reliability of diagnostic test, preoperative observations, and disability after surgery. Of surgeons sampled, 93% estimated incidence of PLF surgery to be less than or equal to 1 per 1000 otolaryngologic outpatient visits. The most reliable diagnostic indicators were history, symptomatology, and tympanometric and electronystagmographic fistula tests. About 72% of surgeons reported less than 4 weeks' average delay before surgery. Most surgeons and patients (greater than or equal to 70%) rated length of disability before return to work, exposure to noise, travel by airplane, swimming, and heavy lifting, at several weeks to several months. Diving was the most restricted activity. Results suggest that incidence of surgery and disability with PFL in the United States is very limited.

Perilymphatic Fistula: A Washington, D.C., Experience

“…Some authors have emphasized certain diagnostic tests, such as the positional tests and eyes-closed turning test [35], fistula tests (SFT [15,29,36,37], ENG [20], PFT [38]), ECochG [22,24], dehydrating tests [39] and positional audiometry [40] as having significant sensitivity and specificity in the diagnosis of PLF. The value of some of these tests is supported in national surveys on the subject [27,41] and in the present series.…”

“…A national survey showed a median hit rate of 50% [27]. For these reasons, a slightly more objective standard is proposed to measure sensitivity and specificity values for diagnostic tests and surgery hit rates.…”

Sudden Sensorineural Hearing Loss after Auto Inflation of the Middle Ear in a Patient with A Stapes Prosthesis

“…Rapid surgical intervention may minimize the degree of hearing loss and vertigo suffered. Often the time to intervention is suboptimal given the typically delayed presentation to an Otolaryngologist [3]. Politzer and Valsalva described techniques by which the middle ear can be inflated via the Eustachian tube [4,5].…”

Perilymph Fistula: Myth or Reality?

“…There is no epidemiological study of this disorder, which can affect both adults and children. According to previously published studies, the estimated incidence of PLF surgery is less than or equal to 1 per 1, 000 otolaryngologic outpatient visits [2], and the mean number of PLF operations per surgeon is 4.6 per year (2.33% of total ear surgery) [3]. PLF causes various, sometimes severe disorders in hearing, balance or both.…”

“…A history of traumatic or iatrogenic events is still the main means of documenting PLF. The disorder can be either posttraumatic, occurring after head injury, barotrauma, blast injury or stapes surgery [2,[4][5][6], or spontaneous or congenital, in which case children are more often affected. There is still debate about the myth or reality of PLF, especially the spontaneous form, and exploratory tympanotomy is not always indicative.…”