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Unilateral sensorineural deafness in children
I H Kielmovitch1, W H Friedman
1Center for Pediatric Otolaryngology, Park Central Institute.
Insights
Perilymphatic fistula may cause unilateral sensorineural deafness in children. Exploratory tympanotomy is crucial for diagnosing and treating this condition, even with normal preoperative tests.
Area of Science:
- Pediatric Otolaryngology
- Neurotology
- Auditory Medicine
Background:
- Unilateral sensorineural deafness in children often stems from heredity, viral infections, or trauma.
- The exact incidence of perilymphatic fistula (PLF) in pediatric unilateral hearing loss remains undetermined.
- Diagnostic options for inner ear issues in children are limited, complicating PLF diagnosis.
Observation:
- Four pediatric patients (ages 5-15) with rapid, progressive unilateral sensorineural hearing loss underwent surgical exploration.
- Preoperative evaluations including fistula tests, ENG, CT scans, and ABR yielded normal results in all cases.
- Overt perilymphatic fistula was confirmed in only one of the four surgically explored children.
Findings:
- Exploratory tympanotomy is the definitive diagnostic method for perilymphatic fistula.
- This surgical procedure can potentially halt or reverse hearing loss and stop middle ear-cranial cavity communication.
- Despite normal non-invasive tests, PLF may be present and require surgical confirmation.
Implications:
- Exploratory tympanotomy should be considered in pediatric cases with a suggestive history of unilateral hearing loss.
- The potential benefits of timely surgical intervention outweigh the risks and morbidity associated with the procedure.
- Early diagnosis and treatment via tympanotomy are vital for managing pediatric sensorineural hearing loss potentially caused by PLF.
Abstract:
Heredity, viral infection, and head or acoustic trauma are considered the common etiologies for a unilateral sensorineural deafness in children. The incidence of perilymphatic fistula in a unilateral hearing loss is still unknown. Inner ear-related symptoms in children are scarce, and little diagnostic laboratory testing is available. A definite diagnosis of a perilymphatic fistula can therefore be made only by an exploratory tympanotomy. Four children, ages 5 to 15 years, with a history of a recent and rapidly progressive unilateral sensorineural hearing loss, were explored. Preoperative laboratory data, which included a fistula test, ENG, CT scan of the temporal bones, and an ABR, were all within normal limits. An overt fistula was found in only one of the patients. Only an exploratory tympanotomy can arrest and possibly reverse a unilateral hearing loss or discontinue a middle ear-cranial cavity communication. It is therefore our feeling that, in patients with an appropriate history, the potential benefit outweighs the risk and morbidity of an exploratory tympanotomy.