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Perilymph fistula--45 case analysis
1Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan. f.goto@irz.uni-muenchen.de
Insights
Diagnosing perilymph fistula (PLF) is challenging due to varied symptoms. Meticulous clinical history and repeated fistula tests are crucial for accurate diagnosis of this inner ear condition.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Perilymph fistula (PLF) diagnosis remains challenging despite its prevalence.
- Exploratory tympanotomy is currently the definitive diagnostic method for PLF.
- Early PLF diagnosis relies heavily on patient history and clinical examinations.
Purpose of the Study:
- To investigate the clinical features of perilymph fistula (PLF).
- To identify factors aiding in earlier and more accurate PLF diagnosis.
- To evaluate the reliability of classic diagnostic procedures for PLF.
Main Methods:
- Retrospective analysis of 44 patients diagnosed with PLF between 1983 and 1998.
- Investigation of clinical symptoms, predisposing factors, and basic test results.
- Assessment of therapeutic outcomes following PLF closure.
Main Results:
- Common symptoms include hearing loss (93%), vertigo/dizziness (91%), and tinnitus (76%).
- Predisposing factors were identified in about half of the patients; others lacked clear triggers.
- Subjective fistula signs were present in 71% of patients, with 80% experiencing symptom improvement after PLF closure.
Conclusions:
- Varied clinical presentations of PLF complicate diagnosis.
- Meticulous clinical history taking is essential for accurate PLF diagnosis.
- Repeated fistula tests and close follow-up improve diagnostic accuracy for PLF.
Purpose Of The Study:
Though perilymph fistula (PLF) is not a rare disease, preoperative diagnosis still remains to be established. Some new diagnostic methods are challenging, but there is still no established diagnostic method except exploratory tympanotomy that verifies the occurrence of leakage. Early diagnosis of PLF is fully depending on history taking and some clinical examinations. To know the clinical features of PLF is one of the greatest helps to make both earlier and accurate diagnosis. In spite of some innovations in clinical examinations classic diagnostic procedure is thought to be still reliable.
Procedures:
We investigated the clinical symptoms, basic tests results and therapeutic results in patients with PLF.
Results:
From 1983 to 1998 PLF was identified in 44 patients (45 ears) with exploratory tympanotomies in our hospital. With respect to clinical history the predisposing factors such as blowing the nose, lifting heavy goods, and landing in an airplane were found in almost half of the patients, while the rest of them had no clear inducing factors. Their major symptoms included hearing loss (93%), vertigo and dizziness (91%), tinnitus (76%), and aural fullness (31%). The patients who have a clear predisposing factor tended to make diagnosis easily; on the other hand the rest of the patients who do not have clear etiology had some diagnostic difficulty. Subjective positive fistula signs were observed in 71% of patients. Vestibular symptoms improved in 80% of patients after closure of PLF.
Conclusions:
These results suggest that the variety of clinical manifestation make diagnosis more difficult. At the moment meticulous clinical history taking and close follow-up applying repeating fistula tests are the most important for not only earlier but also accurate diagnosis.