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Endoscopic Repair of Traumatic Perilymphatic Fistula in Children: A Case Series
Rounak Rawal1, Xue Zhao2, Sophie Lipson3
1Yale New Haven Hospital, New Haven, CT, USA.
Insights
Traumatic perilymphatic fistula (PLF) in children can be effectively managed with endoscopic ear surgery (EES). This minimally invasive approach offers a safe and successful treatment for vestibular symptoms and hearing loss.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Neurosurgery
Background:
- Traumatic perilymphatic fistula (PLF) is a rare cause of vestibular and auditory dysfunction in children after head trauma.
- Management of pediatric traumatic PLF traditionally involves open surgical techniques.
Observation:
- This study details the endoscopic ear surgery (EES) management of three pediatric patients diagnosed with traumatic PLF.
- Patient ages ranged from 10 months to 14 years, with fistulas located at the oval and/or round windows.
- Two patients had associated ossicular chain injuries requiring repair.
Findings:
- All three pediatric patients achieved complete resolution of vestibular symptoms following EES repair.
- No recurrence of symptoms was noted at an average follow-up of 8.3 months.
- A 10-month-old infant required a second-stage endoscopic-assisted surgery due to a severe perilymph leak.
Implications:
- Endoscopic ear surgery (EES) provides a safe and effective method for diagnosing and treating traumatic PLF in pediatric patients.
- An endoscopic-assisted approach may be beneficial for complex cases, considering patient age and leak severity.
- This approach potentially reduces morbidity and improves outcomes for children with traumatic PLF.
Abstract:
Traumatic perilymphatic fistula (PLF) is an uncommon cause of acute vestibular symptoms and hearing loss following head injury in children. We describe the management of 3 pediatric patients with traumatic PLF using an endoscopic ear surgery (EES) approach. Three pediatric patients with traumatic PLF underwent repair via an EES approach between August and October 2018. Patients included a 14-year-old female (oval window), a 13-year-old male (round window), and a 10-month-old male (oval and round window). Ossicular chain injury was identified and repaired in 2 patients. The 10-month-old patient required a second-stage surgery that included lumbar drain placement and a post-auricular, endoscopic-assisted approach due to an especially brisk leak. All patients had complete resolution of vestibular symptoms post-operatively with no recurrence at a mean follow-up of 8.3 months. Traumatic PLF can be safely and effectively diagnosed and managed via an EES approach in children, though an endoscopic-assisted approach may be necessary in select cases due to factors such as patient age and leak severity.
