International Journal of Pediatric Otorhinolaryngology. 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. In , Tonkin and Fagan [ 24 ] reported on thirteen patients with a round window fistula where the initiating event appeared to be direct head trauma in four, but exertion, barotrauma from flying and diving, acoustic trauma, vomiting, and postoperative in the remainder. Seventy-eight ears were explored for reasons which varied over the period. The slipped strut problem, a review of 52 cases.
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. Acknowledgments The author thanks the staff of the Canterbury Medical Library for their assistance in obtaining the papers used for this review. Effects of persistent perilymph fistula on the inner ear. Mechanisms of PLF In a presidential address to the Triological Society Goodhill [ 21 ] advanced a theory of labyrinthine window ruptures as a possible cause of sudden deafness associated with exertion or trauma. The evidence for this came from temporal bone histology, which is time-intensive and expensive. Protein profile of human perilymph:
However, there is agreement that when the predominant symptom is hearing loss recovery of hearing is rare.
Perilymphatic fistula and Meniere’s disease. Clinical series and literature review.
Surgical management of perilymphatic fistulas: Diagnosis and treatment of perilymph fistulas without hearing loss. Certain proof of a fistula at exploration remains problematic. Consequently, the volume of fluid collectable for a chemical test is miniscule. Meanwhile, when a PLF is tistula suspected a simple tympanotomy is justified. If that is the case it should be personally witnessed to confirm spontaneous nystagmus by the clinician.
Many authors emphasise that such likely event can be forgotten, or even concealed by the patient. Only some surgeons were aware of the test results. PLF patients routinely do not describe either of these. High resolution CT can now image normal and abnormal stapes in considerable detail [ 88 ] and has shown a subluxed stapes in an eleven-year-old boy from a traumatic penetrating injury [ 89 ].
No specific diagnostic tests were attempted. The anaesthetist was asked to increase the intrathoracic pressure, resulting in recovery of the AP and decrease in the SP when perilymph refilled the otic capsule. In those where a fistula was found one third had no history of ear surgery or trauma. Evaluation of perilymphatic fistulas by middle ear endoscopy. Gulya and colleagues [ 70 ] also fisfula click stimulus EcochG in guinea pigs before and after creation of a round window fistula with a hook, but without suction.
Beta-2 transferrin assay in the identification of perilymph.
On the left unoperated side the fissula antefenestrum and the round window fissure were not potentially patent. Here, key controversial aspects are discussed with the exception of surgical repair techniques. Perilymphatic fistula in children with preexisting sensorineural hearing loss. Current Neurology and Neuroscience Reports. Platform pressure test in identificaztion of perilymphatic fistula. Abstruce complications of stapes surgery.
Congenital and acquired perilymph fistula: review of the literature.
The theory proposes that a force up an abnormally patent cochlear aqueduct could rupture the basilar membrane and Flstula 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. Imaging of a congenital perilymphatic fistula.
There are extensive reviews on the whole topic, invariably conveying the authors’ own experiences and their confirmed views on various aspects. Urban and Schwarzenberg; The etiology is either congenital or acquired.
Published online Jul They all underwent at least a unilateral PLF repair, and some also underwent an endolymphatic sac-mastoid shunt operation. Gibson has also used the intraoperative EcochG as a method of both proving and disproving the presence of a window fistula.
There is good evidence that head trauma even mild and whiplash can initiate the onset of a PLF.
Support Center Support Center. In all the endoscopy showed no fistula but at tympanotomy there was clear fluid emerging at one or both windows, reinforcing the point that clear fluid may not be perilymph [ 60 ]. In animal models of PLF some animals show histological evidence of hydrops, but this is not proof that hydrops is the cause of the predominant vestibular symptoms in humans.
They stressed that the incident could be long forgotten by the patient.