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Perilymphatic fistulas: can we predict the diagnosis?
Musaed Alzahrani1, Raphaelle Fadous, Jean-Jacque Dufour
1Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, 1560, Sherbrooke East Street, Montreal, QC, H2L 4M1, Canada.
Summary
Predicting perilymphatic fistula (PLF) remains challenging, as surgery is the only confirmation. Middle ear exploration effectively improves vestibular symptoms, even if the PLF is not found.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Perilymphatic fistula (PLF) diagnosis lacks reliable predictive factors, necessitating surgical exploration.
- Current diagnostic methods for PLF are limited, impacting timely and accurate patient management.
Purpose of the Study:
- To identify predisposing factors and clinical findings that could better predict the diagnosis of perilymphatic fistula (PLF).
- To evaluate the effectiveness of middle ear exploration in managing PLF symptoms.
Main Methods:
- Retrospective chart review of 71 patients operated for suspected PLF between 1983 and 2012.
- Patients categorized into fistula-negative (Group I) and fistula-positive (Group II) groups based on intraoperative findings.
- Analysis of predisposing factors, clinical findings, and audiometric parameters pre- and postoperatively.
Main Results:
- No significant differences in predisposing factors or clinical findings were identified between groups, except for a history of partial stapedectomy (p=0.04).
- Significant improvement in vestibular symptoms (91%) and cochlear symptoms (53%) observed postoperatively.
- Group II showed improved pure tone and bone conduction thresholds, but no improvement in air-bone gap or speech discrimination. Group I showed no significant audiometric improvement.
Conclusions:
- This study failed to identify specific factors for predicting PLF diagnosis.
- Middle ear exploration with oval and round window obliteration is effective for managing PLF, particularly for reducing vestibular symptoms, even when the fistula is not identified.
