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Perilymphatic fistula in children with preexisting sensorineural hearing loss
D G Pappas1, L C Simpson, G H Godwin
1Division of Otology, University of Alabama, School of Medicine, Birmingham.
Insights
Progression of sensorineural hearing loss (SNHL) alone does not warrant middle ear exploration for perilymphatic fistula (PLF). Consider exploration only with specific events or radiographic abnormalities, as fistulas are rarely found.
Area of Science:
- Otolaryngology
- Pediatric Audiology
Background:
- Sensorineural hearing loss (SNHL) progression in children often prompts middle ear exploration for perilymphatic fistula (PLF).
- The diagnostic yield and necessity of this approach require critical evaluation.
Purpose of the Study:
- To assess the indication for surgical exploration in children with progressive SNHL.
- To determine the prevalence of PLF in this pediatric population and identify predictive factors.
Main Methods:
- Surgical exploration of 36 middle ears in 26 children with progressive SNHL.
- Correlation of findings with radiographic evidence of inner-ear deformity and history of specific events (exertion, barotrauma).
Main Results:
- Perilymphatic fistula (PLF) was identified in 11% (4/36) of explored ears.
- Only 22% (4/18) of radiographically abnormal ears revealed a definite fistula.
- A fistula was found in only one child with a history suggestive of an inciting event.
Conclusions:
- Progression of SNHL alone is an insufficient indication for middle ear exploration.
- Surgical exploration should be reserved for cases with concurrent history of specific events and/or radiographic inner-ear abnormalities.
- Even with these indicators, the likelihood of finding a PLF remains low.
Abstract:
Progression of preexisting sensorineural hearing loss (SNHL) in infants and children has been considered an indication for fistula exploration: is this approach warranted? On exploring 36 middle ears in 26 such children, we found a perilymphatic fistula (PLF) in four ears (11%). Although there was radiographic evidence of inner-ear deformity in one half of these children, a definite fistula was found in only four of 18 radiographically abnormal ears explored (22%). Even in the four patients with a history of an "event" that could implicate a fistula such as exertion or barotrauma, a fistula was found in only one. There are a number of possible causes for progression of a preexisting SNHL, and surgical exploration of the middle ear should not be recommended on the basis of progression alone. Instead, exploration for a suspected PLF should be strongly considered when there is also a history of an "event", and/or radiographic evidence of inner-ear abnormalities. Even under these conditions, one should be aware that fistulae are not likely to be found.