Rundfensterruptur - Nachweis mittels Fluoreszenzendoskopie

Abstract

Rupture of the round window membrane as a special cause of inner ear deafness is widely accepted after changing pressure levels, e.g. in diving. However, even without a barotrauma before, the spontaneous rupture of the round window membrane is suspected occasionally in patients with sudden hearing loss and/or vertigo and tinnitus. To carry through the tympanotomy is decided by ENT surgeons often in cases of progressive hearing loss despite infusion therapy. Perilymph fistulas have been detected relatively seldom, compared to the number of reported operations by several authors. However, covering the round niche with connective tissue leads to the improvement of symptoms sometimes even in cases without microscopical evidence of fistula. Within the last 3 years 14 patients suffering sudden hearing loss of one ear underwent tympanotomy in our department. Of these patients 8 reached restitution of the hearing ability. Especially 2 patients with sudden deafness caused by spontaneous rupture of the round window membrane are reported in the following article. Perilymph fistulas were detected in these cases by IV-application of fluorescein and fluorescence endoscopy of the middle ear. Both patients obtained a normal hearing curve within 1 week after surgical intervention and obliteration of the round niche.

Occurence of a round window membrane rupture in patients with sudden sensorineural hearing loss

“…There are different reports of intraoperative findings [10,11] and diagnostic instruments to visualize a perilymphatic fistula [10]. Many institutions recommend the exploratory tympanotomy, including an obliteration of the round window niche under local anesthesia [12,13].…”

Messung von β-trace-Protein zum Nachweis von Perilymphfisteln

“…Nicht selten waren eindeutige Perilymphproben negativ für β 2 -Transferrin, sodass dieser Nachweis für Innenohrflüssigkeiten keine weitere Verbreitung gefunden hat [13]. Die Möglichkeit, i.v.-Natrium-Fluoreszein anzuwenden, erfordert eine Tympanoskopie oder Tympanotomie und zählt damit zu den invasiven Methoden [11].…”