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Cochlin-tomoprotein test and hearing outcomes in surgically treated true idiopathic perilymph fistula
Manabu Komori1, Yutaka Yamamoto1, Yuichiro Yaguchi1
1a Department of Otorhinolaryngology , The Jikei University School of Medicine , Tokyo , Japan ;
Insights
Early surgery for spontaneous perilymph fistula (sPLF) improves hearing outcomes. The cochlin-tomoprotein (CTP) test aids in diagnosing sPLF, with about half of clinically diagnosed cases being CTP-positive.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Idiopathic spontaneous perilymph fistula (sPLF) diagnosis is challenging.
- sPLF is suspected in cases of acute sensorineural hearing loss with vertigo, progressing despite steroid treatment.
Purpose of the Study:
- Evaluate cochlin-tomoprotein (CTP) test utility in sPLF diagnosis.
- Assess surgical outcomes in patients with sPLF, correlating with CTP test results.
Main Methods:
- Retrospective study of 23 patients diagnosed with sPLF undergoing exploratory tympanotomy.
- Analysis of CTP test results and post-operative hearing outcomes.
Main Results:
- CTP test was positive in 11 out of 23 patients.
- CTP-positive patients showed significant hearing improvement post-surgery (mean 66.5 dB pre-op to 42.3 dB post-op).
- Surgery within 7 days of onset yielded significantly better hearing recovery than later intervention.
Conclusions:
- Approximately 50% of clinically diagnosed sPLF cases were confirmed as CTP-positive.
- Early surgical intervention (within 7 days) is crucial for improving therapeutic response in hearing loss associated with sPLF.
Conclusion:
Approximately 50% of patients with sPLF based on the clinical diagnosis criteria were definitively diagnosed with CTP-positive sPLF. These results suggest that early surgery within 7 days of the disease onset contributes to improvements in the therapeutic response of hearing loss.
Objectives/Hypothesis:
Idiopathic spontaneous perilymph fistula (sPLF) cannot be diagnosed reliably. It is speculated that this condition occurs in patients with vertigo-accompanied acute sensorineural hearing loss that progresses rapidly in spite of steroid therapy. This study herein evaluated cochlin-tomoprotein (CTP) test results in patients with sPLF who underwent exploratory tympanotomy and considered surgical outcomes with true sPLF.
Study Design:
Retrospective study.
Methods:
Twenty-three patients diagnosed with sPLF based on the clinical diagnosis criteria who underwent exploratory tympanotomy were included.
Results:
CTP test results were positive in 11 cases. In CTP-positive cases, the mean hearing level was 66.5 dB pre-operatively and 42.3 dB post-operatively. The hearing level post-operatively completely recovered in four cases, markedly recovered in three cases, slightly recovered in one case and showed no response in three cases. Hearing level improvements were significantly better in CTP-positive patients who underwent surgery within 7 days of the disease onset than in those treated 8 or more days after the disease onset.
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