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Perilymph fistula: the Stanford experience.
1Division of Otolaryngology and Head and Neck Surgery, Stanford Medical School, California.
The Annals of Otology, Rhinology, and Laryngology
|March 1, 1988
Summary
Perilymph fistulas (PLFs) were found in 51% of patients undergoing tympanotomy. Surgery outcomes suggest PLFs may be epiphenomena, with stabilization, not hearing restoration, being a more realistic surgical goal.
Area of Science:
- Otolaryngology
- Neurosurgery
- Auditory Medicine
Background:
- Perilymph fistulas (PLFs) are abnormal openings between the middle and inner ear.
- Diagnosis and surgical management of PLFs remain challenging.
- The role of PLFs in sudden hearing loss and balance disorders is debated.
Purpose of the Study:
- To evaluate the diagnostic yield of tympanotomy for PLFs.
- To assess the surgical outcomes of grafting oval and round windows in PLF cases.
- To determine the efficacy of PLF repair in restoring hearing and resolving symptoms.
Main Methods:
- Seventy-eight tympanotomies were performed for suspected PLFs.
- Oval and round windows were grafted in all patients, regardless of PLF presence.
- Symptom resolution was assessed post-operatively.
Main Results:
- Perilymph fistulas were identified in 51% of the tympanotomies.
- Symptom resolution occurred in 64% of patients with PLFs and 44% without PLFs.
- Surgical outcomes for hearing restoration in sudden hearing loss were disappointing compared to spontaneous recovery rates.
Conclusions:
- PLFs may act as epiphenomena in relation to hearing and balance symptoms.
- PLFs can present intermittently, complicating diagnosis.
- Stabilizing fluctuating or progressive hearing loss is a more achievable surgical goal than complete hearing restoration.
- Preoperative criteria for surgical exploration for PLFs require further refinement.