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Cochlear basal turn patency in unrecognized perilymph gushers.

Varun V Varadarajan1, Orrin L Dayton2, Reordan O De Jesus2

  • 1Department of Otolaryngology, University of Florida, Gainesville, FL, USA.

International Journal of Pediatric Otorhinolaryngology
|August 2, 2019
PubMed
Summary

Subtle defects between the cochlea and internal auditory canal (IAC) increase perilymph gusher (PLG) risk during otologic surgery. A CT scan width greater than 0.75 mm indicates a significant risk for PLG.

Keywords:
Cochlear implantComputed tomographyInner ear deformityPerilymph gusherStapedotomyTemporal bone imaging

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Radiology

Background:

  • Perilymph gusher (PLG) is an infrequent complication of otologic surgery.
  • It is often caused by a communication between the cochlea and the internal auditory canal (IAC).
  • Standard axial computed tomography (CT) may miss subtle osseous defects.

Purpose of the Study:

  • To measure cochlear basal turn patency not visible on axial CT in patients who experienced PLG.
  • To compare these measurements with patients who did not experience intraoperative PLG.

Main Methods:

  • Retrospective review of 61 ears that underwent cochlear implantation or stapedotomy with preoperative CT scans interpreted as normal.
  • Independent, blinded measurements of cochlear basal turn patency along the cochlea-IAC interface by an otologist and radiologist.
  • Measurements were taken in oblique and parasagittal planes.

Main Results:

  • Three ears with surgically confirmed PLGs and 12 with apparent dehiscence but no PLG were analyzed.
  • The mean defect width in ears with PLG was 0.83 mm, compared to 0.43 mm in ears without PLG (p=0.011).
  • A higher proportion of PLGs occurred in ears with defects (3/15) versus those without (0/46, p=0.013).
  • A defect width greater than 0.75 mm was associated with a higher incidence of PLG (3/3) compared to defects smaller than 0.75 mm (0/12, p=0.022).

Conclusions:

  • CT evidence of dehiscence between the IAC and the cochlear basal turn is a risk factor for PLG.
  • A CT defect width greater than 0.75 mm should be considered a significant risk indicator for PLG during stapedotomy or cochlear implantation.