Perilymph fistulas in infants and children
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Exploratory tympanotomies identified perilymph fistulas (PLF) in 66% of pediatric cases. Surgical repair resolved vertigo, with hearing stable in 86% of ears, aiding diagnosis of this inner ear anomaly.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Neurotology
Background:
- Perilymph fistula (PLF) is a potential cause of sensorineural hearing loss and vertigo in children.
- Diagnosis can be challenging, often requiring surgical exploration.
Purpose of the Study:
- To evaluate the diagnostic yield of exploratory tympanotomy for suspected pediatric PLF.
- To assess surgical outcomes, including hearing and vertigo, following PLF repair.
Main Methods:
- Exploratory tympanotomies were performed on 33 infants and children (44 ears) between 1975 and 1981.
- Preoperative factors and intraoperative findings were analyzed.
- Audiological and vestibular outcomes were assessed post-surgery.
Main Results:
- A PLF was identified in 29 (66%) of the 44 ears explored, often involving the round or oval windows.
- Vertigo resolved in all cases where PLF was repaired.
- Hearing remained unchanged in 86% of ears post-surgery, with improvement in 5% and worsening in 9%.
- Suggestive preoperative factors included sudden sensorineural hearing loss, congenital head deformities, and inner ear dysplasias.
Conclusions:
- Exploratory tympanotomy is an effective method for diagnosing PLF in children.
- Surgical intervention can successfully resolve vertigo associated with PLF.
- While hearing outcomes vary, surgical repair offers a chance for stabilization or improvement.
Abstract:
During the years 1975 through 1981 we performed exploratory tympanotomies on 33 infants and children (44 ears) to verify the presumptive diagnosis of perilymph fistula (PLF). A PLF was identified at the round window, oval window, or both in 29 (66%) of the 44 ears explored. After surgery hearing was unchanged in 86%, improved in 5%, and worsened in 9% of the ears in which PLFs had been observed. Complaints of vertigo subsided in all children in whom a PLF was repaired. Preoperative factors determined to be highly suggestive of the presence of a PLF included the following: sudden onset of sensorineural hearing loss (SNHL), congenital deformities of the head, and abnormal findings on tomograms of the temporal bones, especially Mondini-like inner ear dysplasias. Middle ear abnormalities (primarily congenital) were observed in 20 of the 44 ears. Abnormal results of preoperative vestibular function studies, which included a fistula test, and sex were not consistently found to be associated with an observed PLF at tympanotomy.