Diagnosis and Treatment of Perilymph Fistulas without Hearing Loss

Abstract

In 1978, I reported on the diagnostic criteria and therapy based on the treatment of 34 cases of perilymph fistula. Of that group, 20 patients had no hearing loss associated with the fistula. Since that time, an additional 30 cases of fistula--15 without hearing loss--have been seen and treated operatively. The 30 significant variables of history and physical findings identified in the first study were statistically reviewed, along with a new finding that seems highly significant. Twenty-three of the 26 new cases so evaluated had a positive "eyes-closed turning test" (staggering when turning to the side of the lesion after walking with eyes closed). A further finding has been the presence of an abnormally placed round window membrane, in most cases involving the round window. The total operative population of fistulas, both those with and without hearing loss, is reviewed to identify the operative technique best suited for each window and the graft material most likely to succeed. Perichondrium is the choice tissue for graft material, except for very small fistulas at the annular ligament. The graft must be held firmly in place, with either a prosthesis or appropriate packing, carefully avoiding adhesions between the round window and the tympanic membrane.

The Perilymph Fistula Syndrome Defined in Mild Head Trauma

“…e.g. Singleton (1984) have noted, surgically verified fistulas are frcqucntly found in the absence of SNHL. A hearing loss >20 d B was prcscnt in 53% o f our PLFS cases.…”

A Third Labyrinthine Window: An Overview of Perilymph and Labyrinthine Fistulae and Superior Semicircular Canal Dehiscence

“…Nystagmus may be seen on examination. In the literature vertigo and nystagmus are regarded as an indicator of PLF 13,[26][27][28] reported that only 18% of patients could be operated on the basis of this complaint alone. A pure tone audiometric analysis would reveal a sensorineural hearing loss in majority of patients.…”

Perilymphatic fistula

“…Further, a mixed hearing loss may also be encountered, as traumatic fistula may be associated with conductive hearing loss from middle ear pathology. Notably, hearing may be entirely normal in a substantial percentage of patients [21]. Electronystagmography (ENG) may or may not show positional or spontaneous nystagmus or caloric asymmetry in perhaps 50% to 75% of patients.…”

“…Friedland and Wackym [20••] summarize the surgical experience at several institutions, which show overall improvement rate in vestibular symptomatology approximating 90%, whereas stabilization of hearing may be achieved in approximately 50% of patients, and improvement of hearing in a substantially lower percentage. No study has confirmed that some fistulas heal less well than others; however, the literature implies that the more severe the trauma, the less chance for spontaneous healing [21,22]. Following surgical intervention, postoperative care is about the same as that described following stapedectomy [14].…”