[Rupture of the round window--detection with fluorescence endoscopy]

Area of Science:

• Otolaryngology
• Neuroscience
• Audiology

Context:

• Round window membrane (RWM) rupture is a known cause of inner ear deafness, often linked to pressure changes like diving.
• Spontaneous RWM rupture is occasionally suspected in sudden hearing loss (SHL), vertigo, and tinnitus, even without barotrauma.
• Tympanotomy is frequently considered by ENT surgeons for progressive hearing loss unresponsive to infusion therapy.

Purpose:

• To investigate the efficacy of tympanotomy in patients with suspected spontaneous round window membrane rupture.
• To report on the diagnostic methods and surgical outcomes for perilymph fistulas.
• To highlight the successful treatment of sudden deafness caused by spontaneous RWM rupture.

Summary:

• Fourteen patients with sudden unilateral hearing loss underwent tympanotomy over three years; eight achieved hearing restitution.
• Two specific cases of sudden deafness attributed to spontaneous RWM rupture are detailed.
• Perilymph fistulas were diagnosed using fluorescein and fluorescence endoscopy, leading to surgical intervention and round niche obliteration.

Impact:

• Surgical intervention and obliteration of the round niche resulted in normal hearing curves within one week for both reported patients.
• This study suggests that even without clear microscopic evidence of a fistula, covering the round niche can improve symptoms.
• The findings support tympanotomy as a viable treatment for sudden hearing loss potentially caused by spontaneous round window membrane rupture.