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[Perilymphatic fistula]
B Angelard1, M François, P Viala
1Service ORL, Hôpital Robert Debre, Paris.
Insights
Perilymphatic fistulae, a cause of hearing loss in children, can be identified using computed tomography. Surgical exploration can stabilize hearing, though significant improvements are rare, with low morbidity.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Perilymphatic fistulae are a primary cause of perceptive deafness in children.
- These cases often present with progressive or fluctuating hearing loss of unknown origin.
- Surgical intervention is a potential treatment for this condition.
Purpose of the Study:
- To analyze the efficacy of surgical exploration for perilymphatic fistulae in children.
- To identify the most effective diagnostic criteria for surgical indication.
- To evaluate the outcomes and morbidity associated with the surgical treatment.
Main Methods:
- Retrospective analysis of 48 ear explorations in 37 children with unexplained perceptive deafness.
- Utilized computed tomography (CT) to assess the patency of the aqueduct of the cochlea as a selection criterion.
- Surgical exploration focused on identifying and addressing perilymphatic fistulae, particularly at the fissura ante fenestram.
Main Results:
- Computed tomography proved efficient in selecting patients for surgical exploration.
- Hearing stabilization was the primary outcome, with significant hearing improvements being infrequent.
- The study observed low morbidity, with complications mainly related to incomplete fistula closure.
Conclusions:
- Surgical exploration for perilymphatic fistulae in children can lead to hearing stabilization.
- CT is a valuable tool for identifying surgical candidates.
- Further research is necessary to elucidate the pathophysiology and long-term outcomes of perilymphatic fistulae treatment.
Abstract:
Perilymphatic fistulae are the first cause of perceptive deafness that may be amenable to surgical treatment. After a complete study of the literature, we have made a retrospective analysis of 48 ear explorations in 37 children. These children presented with a variable degree of progressive or fluctuating perceptive deafness without any obvious etiology. Computed tomography, especially aimed at detecting an abnormality in the patency of the aqueduct of the cochlea, seems to be the most efficient criterion of selection to establish an indication for surgical exploration. The extent of the perilymphatic fistulae and their location, mainly at the level of the fissura ante fenestram, call to our mind the possibility of an arrest in the differentiation of the otic capsule, with a persistent anomalous patency of the aqueduct of the cochlea. The results of this study mainly demonstrate stabilizations of hearing, while spectacular improvements still are anecdotal. On the other hand, morbidity is very low and mainly results from insufficient surgery to fill in the fistula. Further studies are needed, especially to better understand the pathophysiology of the perilymphatic fistulae, and their results must certainly be appreciated in the longer term.