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Saliba I, Bawazeer N, Belhassen S. Suspicion and Treatment of Perilymphatic Fistula: A Prospective Clinical Study. Audiol Res 2024; 14:62-76. [PMID: 38247562 PMCID: PMC10801529 DOI: 10.3390/audiolres14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Background: Since the discovery of the perilymphatic fistula (PLF), the diagnosis and treatment remain controversial. If successfully recognized, the PLF is surgically repairable with an obliteration of the fistula site. Successful treatment has a major impact on patient's quality of life with an improvement in their audiological and vestibular symptoms. Objective: To prospectively investigate patients' clinical and audiological evolution with PLF suspicion after middle ear exploration and obliteration of the round and oval window. Study Design: Prospective comparative study. Setting: Tertiary care center. Methods: Patients were divided into two groups: Group I consisted of patients where no PLF had been identified intraoperatively at the oval and/or at the round window, and Group II consisted of patients where a fistula had been visualized. Patient assessment was a combination of past medical history, the presence of any risk factors, cochlear and vestibular symptoms, a physical examination, temporal bone imaging, audiograms, and a videonystagmogram (VNG). Results: A total of 98 patients were divided into two groups: 62 in Group I and 36 in Group II. A statistically significant difference regarding gender was observed in Group II (83.3% of males vs. 16.7% of females, p = 0.008). A total of 14 cases (4 and 10 in Groups I and II, respectively) were operated for a recurrent PLF. Fat graft material was used in the majority of their previous surgery; however, no difference was found when comparing fat to other materials. In addition, no statistically significant difference was noted between Groups I and II concerning predisposing factors, imaging, VNG, symptom evolution, or a physical exam before the surgery and at 12 months post-operative. However, both groups showed statistically significant hearing and vestibular improvement. On the other hand, the air conduction (AC) and bone conduction (BC) at each frequency were not statistically different between the two groups before surgery but showed statistically significant improvement at 12 months post-operatively, especially for the BC at the frequencies 250 (p = 0.02), 500 (p = 0.0008), and 1000 Hz (p = 0.04). Conclusions: Whenever you suspect a perilymphatic fistula, do not hesitate to explore middle ear and do window obliterations using a tragal perichondrium material. Our data showed that cochlear and vestibular symptoms improved whether a fistula had been identified or not.
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Affiliation(s)
- Issam Saliba
- Division of Otolaryngology-Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
- University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC H2X 0A9, Canada
- University of Montreal Hospital Centre (CHUM), Montreal, QC H2X 3E4, Canada
| | - Naif Bawazeer
- Division of Otolaryngology-Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Sarah Belhassen
- Division of Otolaryngology-Head & Neck Surgery, University of Montreal, Montreal, QC H3C 3J7, Canada
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Bhatia H, Agarwal P, Kaur R, Pol S. Congenital Peri-Lymphatic Fistula: is CT Imaging Enough? Indian J Otolaryngol Head Neck Surg 2023; 75:4148-4150. [PMID: 37974808 PMCID: PMC10645794 DOI: 10.1007/s12070-023-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 11/19/2023] Open
Abstract
Congenital SNHL patients uncommonly present with radiologically evident anomalies. While inner ear malformations are found in a small percentage of such cases, congenital peri-lymphatic fistula is an even rarely reported entity. We present such a case of a two-year old child who was diagnosed with both the entities on comprehensive imaging with CT as well as MRI. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03893-0.
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Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Purnima Agarwal
- Department of Radiodiagnosis and Imaging, Government Medical College and Hospital, sector 32, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis and Imaging, Government Medical College and Hospital, sector 32, Chandigarh, India
| | - Shashikant Pol
- Department of ENT and head neck surgery Dr. Vasant Rao Pawar Medical College and Research Centre, Nashik, India
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Ito Y, Seo T, Sasano Y, Mochizuki F, Koizuka I. Perilymphatic fistula with characteristic findings of the inner ear by contrast-enhanced magnetic resonance imaging: a case report. Front Neurol 2023; 14:1276991. [PMID: 37928144 PMCID: PMC10625405 DOI: 10.3389/fneur.2023.1276991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
A perilymphatic fistula (PLF) presents with abnormal traffic in the otic capsule, causing cochlear and vestibular symptoms. However, the mechanisms underlying symptom recurrence remain controversial. Herein, we report the case of a 27-year-old female who complained of hearing disturbance in her right ear and recurrent vertigo after sudden onset of hearing loss with vertigo. The caloric test revealed unilateral weakness in the right ear, and the video head impulse test (vHIT) showed decreased vestibulo-ocular reflex (VOR) gain. Contrast-enhanced magnetic resonance imaging (MRI) using hybrid of reversed image of positive endolymph signal and negative image of perilymph signal (HYDROPS) indicated a collapsed endolymphatic space. As the vestibular symptoms did not improve, an exploratory tympanotomy was performed on the right ear. Although perilymph leakage was not noted in the oval or round windows, both windows were sealed with connective tissue. The patient's vestibular symptoms rapidly improved after surgery, and postoperative contrast-enhanced MRI showed improvement in the collapsed endolymphatic space. Although the caloric test revealed unilateral weakness, the VOR gain on the vHIT improved to normal on the right side. Thus, these findings indicated that recurrent symptoms caused by PLF are associated with a collapsed endolymphatic space. We speculate that the collapsed endolymphatic space was due to a ruptured Reissner's membrane. We hypothesized that sealing the fistula would promote normalization of perilymph pressure. The ruptured Reissner's membrane may have been gradually repaired as vestibular symptoms improved. This case adds to the existing literature on the occurrence of the "double-membrane break syndrome". Collapse of the endolymph due to a ruptured Reissner's membrane may be the cause of PLF symptoms.
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Affiliation(s)
- Yusuke Ito
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toru Seo
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Yoshiyuki Sasano
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumihiro Mochizuki
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Izumi Koizuka
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
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Seo T, Kemmochi A, Koike Y, Aomi M, Shinohe T, Komori M. Case report: Perilymphatic fistula from a round window microfissure. Front Neurol 2023; 14:1281023. [PMID: 37840937 PMCID: PMC10575477 DOI: 10.3389/fneur.2023.1281023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
A microfissure near the round window niche is an anatomical structure that communicates between middle ear and the ampulla of the posterior semicircular canal. It has been suggested that the microfissure can cause inner ear symptoms; however, the etiology has not yet been confirmed clinically. We report, to our knowledge, the first case of microfissure with complaint of hearing loss and vertigo and improvement in hearing after surgical sealing of the microfissure. A 50-year-old man complained of hearing disturbance, tinnitus with flowing-water sound in the left ear, and a floating sensation upon pushing the left tragus. He had moderate sensorineural hearing loss (43.3 dB) in the left ear for 3 days. His hearing worsened and he complained of severe vertigo. An exploratory tympanotomy was performed 8 days after onset. A microfissure and accumulation of clear fluid in the floor of the round window niche were detected, and leakage point was packed with connective tissue. One month after surgery, his hearing (20.0 dB) and disequilibrium had improved. The inner ear symptoms improved after the surgery in this case, suggesting that the microfissure might have caused the symptoms.
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Affiliation(s)
- Toru Seo
- Department of Otolaryngology, Yokohama Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Arata Kemmochi
- Department of Otolaryngology, Yokohama Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Yosuke Koike
- Department of Otolaryngology, Yokohama Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Mizuho Aomi
- Department of Otolaryngology, Yokohama Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Tatsuya Shinohe
- Department of Otolaryngology, Yokohama Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Manabu Komori
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
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Amernik K, Twardowska R, Jaworowska E. The Tullio effect in a patient qualified for cochlear implantation: Diagnosis, management and rehabilitation performance: A case report. Medicine (Baltimore) 2022; 101:e31867. [PMID: 36401400 PMCID: PMC9678553 DOI: 10.1097/md.0000000000031867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE A case study on the qualification and treatment of profound hearing loss with a cochlear implant in a patient with a positive Tullio effect is described. To our knowledge this is the first such case reported in the literature. PATIENT CONCERNS A 46-year-old woman was admitted due to sudden hearing loss in the right ear (RE). The patient had suffered from bilateral hearing loss since childhood and was fitted with hearing aids on the RE successfully, in contrast to the left ear. While undergoing pure-tone audiometry, a positive Tullio effect was observed in the RE. The average hearing threshold for the RE was 95 dB. Due to the lack of effective treatment for sudden hearing loss, the patient was qualified for cochlear implantation. The patient's attempts to place a hearing aid on the RE resulted in dizziness. DIAGNOSES Computed tomography excluded the presence of a perilymphatic fistula, which could have been the cause of the patient's vertigo. INTERVENTIONS During the surgical procedure of cochlear implantation, considering the possible mechanisms of the Tullio effect, the incus was removed and the niche of the oval window was filled with fragments of connective tissue. The postoperative course was uneventful. OUTCOMES Three months after implantation, speech intelligibility in the free field was 80% of the correctly repeated elements of the numerical test, at 65 dB sound pressure level. An acoustic stimulation test was performed during tonal audiometry and no preexisting symptoms were observed. LESSONS A positive Tullio effect does not contraindicate treating hearing loss by means of cochlear implantation. When the Tullio effect is present, it is necessary to exclude presence of perilymphatic fistula. During cochlear implant surgery, in a patient with a positive Tullio effect, it is reasonable to disconnect the ossicular chain with the simultaneous sealing of the oval window niche.
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Affiliation(s)
- Katarzyna Amernik
- Department of Otolaryngology, Pomeranian Medical University, Szczecin, Poland
- * Correspondence: Katarzyna Amernik, Department of Otolaryngology, Pomeranian Medical University, Szczecin 71-252, Poland (e-mail: )
| | - Renata Twardowska
- Department of Otolaryngology, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Jaworowska
- Department of Otolaryngology, Pomeranian Medical University, Szczecin, Poland
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Koksal A, Ayyildiz V, Ogul H, Kantarci M. Case Report of a Patient With Posttraumatic Perilymphatic Fistula. Ear Nose Throat J 2022:1455613221131302. [PMID: 36193877 DOI: 10.1177/01455613221131302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
On a perilymphatic fistula, there is an extravasation of the perilymph fluid into the middle ear cavity. Cross-sectional imaging techniques have very important role in evaluation of inner and middle ear structures and temporal bone. While thin section CT scans can show successfully pneumolabyrinth and temporal bone fracture, high-resolution 3D volumetric MRI sequences can help to demonstrate posttraumatic ear effusion and cerebrospinal fluid fistula into inner ear or middle ear.
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Affiliation(s)
- Ali Koksal
- Ankara Private Bayindir Hospital, Ankara, Turkey
- Department of Radiology, Vocational School of Health Services, Atilim University, Ankara, Turkey
| | - Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Lee JM, Lee HJ. Traumatic Stapes Luxation into the Vestibule. Ear Nose Throat J 2022:1455613221106215. [PMID: 35638440 DOI: 10.1177/01455613221106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of traumatic stapes luxation into the vestibule. A 31-year-old female visited an emergency room with sudden onset of vertigo and conductive hearing loss after accidental penetrating injury to the right ear. Temporal bone computed tomography detected pneumolabyrinth, with a shade of whole intact stapes in the vestibule. Under exploratory tympanotomy, we observed a separated incudostapedial joint, and the stapes was depressed into the vestibule. The stapes was pulled out to the middle ear, and stapedectomy was performed; the crus were cut, the suprastructure was removed, and the fractured footplate and the long process of the incus were connected with a piston wire. The stapes footplate was sealed with soft tissue and surgical glue. Vertigo rapidly subsided after surgery, and hearing was improved to normal range. However, hearing loss at high frequencies was not recovered, probably because of inner ear damage due to the stapes depressed into the vestibule or surgical manipulation within the vestibule. Traumatic ossicular dislocation is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. Here, we report a rare case with successful repair. This report could serve as a basis for proper treatment in similar cases in the future.
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Affiliation(s)
- Jeon Mi Lee
- Department of Otorhinolaryngology, 119750Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, 183696Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Qureshi HA, Zeitler DM. Intratympanic Steroid Injection Complicated by Iatrogenic Perilymphatic Fistula: A Cautionary Tale. Laryngoscope 2021; 131:2088-2090. [PMID: 33973652 DOI: 10.1002/lary.29613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022]
Abstract
Intratympanic (IT) steroid therapy is a mainstay treatment for sudden sensorineural hearing loss (SSNHL) for both initial therapy and salvage therapy. We report a rare case of iatrogenic perilymphatic fistula that resulted from trauma during an IT steroid injection for SSNHL. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature. Laryngoscope, 131:2088-2090, 2021.
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Affiliation(s)
- Hannan A Qureshi
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Daniel M Zeitler
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
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9
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Abstract
BACKGROUND Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. OBJECTIVES To analyse the effect of using or not using Gelfoam® as a sealing material. METHODS A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. RESULTS The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634). CONCLUSION AND SIGNIFICANCE No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.
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Affiliation(s)
- Naif Bawazeer
- Department of Otolaryngology-Head & Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sandra Zaouche
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Tringali
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Maxime Fieux
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Ashman PE, Jyung RW. Perilymphatic Fistula Manifesting as a Pseudomeningocele-Like Presentation Following Stapedectomy. Ear Nose Throat J 2020; 101:NP232-NP234. [PMID: 33035130 DOI: 10.1177/0145561320965200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Peter E Ashman
- Department of Otolaryngology-Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert W Jyung
- Department of Otolaryngology-Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
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Sarna B, Abouzari M, Merna C, Jamshidi S, Saber T, Djalilian HR. Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment. Front Neurol 2020; 11:1046. [PMID: 33041986 PMCID: PMC7522398 DOI: 10.3389/fneur.2020.01046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
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Affiliation(s)
- Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Shahrnaz Jamshidi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Tina Saber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, CA, United States
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12
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熊 潇, 于 进, 孙 宇. [The diagnostic value of cochlin-tomoprotein in perilymphatic fistula]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:857-861. [PMID: 33040516 PMCID: PMC10127733 DOI: 10.13201/j.issn.2096-7993.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 04/30/2023]
Abstract
Perilymphatic fistula(PLF) is defined as an abnormal communication between the fluid(perilymph) -filled space of the inner ear and the air-filled space of the middle ear and mastoid, or cranial spaces. At present the diagnostic criteria for perilymphatic fistula is the fistula hole confirmed by the microscope and endoscope between the middle ear and inner ear, the hole is located in the round or oval window, fractured bony labyrinth, microfissures, anomalous footplate, and can occur after head trauma or barotrauma, chronic inflammation, or in otic capsule dehiscence. Recently, the cochlin-tomoprotein(CTP) detected from the middle ear. CTP, the shortest isoform of cochlin encoded by the COCH gene, has been proven to be a perilymph-specific protein which is not expressed in blood, cerebrospinal fluid and saliva but is highly expressed in lymphatic fluid of the inner ear and is used as a diagnostic biochemical marker for perilymph fistula. The CTP test based on ELISA was performed on the lavage fluid of patients with suspected perilymph fistula to obtain comparatively accurate test results. This paper reviewed the diagnostic value of CTP in perilymphatic fistula.
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Affiliation(s)
- 潇 熊
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)
| | - 进涛 于
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)
| | - 宇 孙
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)
- 孙宇,
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13
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Bannikov SA, Boiko NV, Pisarenko EA, Kolesnikov VN. [Traumatic perilymphatic fistula with the luxation of the stapes into vestibule]. Vestn Otorinolaringol 2019; 84:61-64. [PMID: 31486430 DOI: 10.17116/otorino20198403161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of perilymphatic fistula with the luxation of the stapes into vestibule was described, which was caused by a direct damage of the eardrum (the patient cleaned the right ear with a cotton swab and received a strong blow to the arm). The moment of injury was characterized by severe pain, a significant hearing loss, the appearance of tympanophonia and vertigo. Clinical examination revealed the eardrum rupture. After perforation healing the hearing did not improve, a high degree of mixed sensorineural hearing loss remained with a bone-air interval of up to 50 dB throughout the tone scale. CT of the temporal bones showed a pneumolabirinth and a change in the malleus position, which made it possible to suggest the presence of a perilymphatic fistula with the luxation of the stapes. The extent of damage was confirmed by surgery. The stapes was removed and the perilymphatic fistula was closed.
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Affiliation(s)
- S A Bannikov
- Regional Consultative-Diagnostic Center, Rostov-on-Don, Russia, 344000
| | - N V Boiko
- ENT department of Rostov State Medical University, Rostov-on-Don, Russia, 344022
| | - E A Pisarenko
- Regional Consultative-Diagnostic Center, Rostov-on-Don, Russia, 344000
| | - V N Kolesnikov
- ENT department of Rostov State Medical University, Rostov-on-Don, Russia, 344022
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Mallen JR, Roberts DS. SCUBA Medicine for otolaryngologists: Part I. Diving into SCUBA physiology and injury prevention. Laryngoscope 2019; 130:52-58. [PMID: 30776099 DOI: 10.1002/lary.27867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Introduce pertinent self-contained underwater breathing apparatus (SCUBA) physiology and corresponding terminology. Appreciate the scope of diving and related otolaryngological injury. Illustrate pathophysiologic mechanisms for diving injuries. Summarize strategies for ear, paranasal sinus, and lung barotrauma prevention, including medical optimization and autoinsufflation techniques. METHODS We conducted a review of the available medical and diving literature in English, German, Spanish, Italian Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers. The databases of PubMed, Ovid Medline, and the Cochrane library, as well available textbooks, were queried for relevant data. RESULTS Divers are subjected to large pressure gradients within the first few meters of descent. This can lead to gas embolism formation as well as barotrauma secondary to gas expansion/compression in potential closed spaces such as the middle ear, paranasal sinuses, and lungs. Physicians can minimize the risk of injury by counseling patients regarding proper equalization and descent/ascent techniques, and optimizing sinonasal and eustachian tube function. The use of decongestants is controversial. CONCLUSIONS Diving is an increasingly popular sport with predominantly otolaryngologic manifestations of injury and disease. Treating SCUBA divers requires a firm understanding of how physiology is altered underwater. This review presents the relevant background information using illustrations to understand the environmental forces acting on divers and how to prevent injury. Laryngoscope, 130:52-58, 2020.
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Affiliation(s)
- Jonathan R Mallen
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A
| | - Daniel S Roberts
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A
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15
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Fujita T, Kobayashi T, Saito K, Seo T, Ikezono T, Doi K. Vestibule-Middle Ear Dehiscence Tested With Perilymph-Specific Protein Cochlin-Tomoprotein (CTP) Detection Test. Front Neurol 2019; 10:47. [PMID: 30761077 PMCID: PMC6363674 DOI: 10.3389/fneur.2019.00047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
An 8-year-old boy was referred to the ENT department for further evaluation of right-sided conductive hearing loss. A small cyst anterior to the oval window and fixation of the stapes footplate were observed during an exploratory tympanotomy. The concentration of a perilymph-specific protein, cochlin-tomoprotein (CTP), in the middle ear lavage fluid was measured with an ELISA-based CTP detection kit. The level of CTP in the middle ear lavage fluid before fenestration of the cyst was 0.26 ng/ml (negative), and its level after fenestration was 2.98 ng/ml (positive), confirming the presence of perilymph in the cyst. A small bone dehiscence, considered to be the fissula ante fenestram, was observed anterior to the stapes footplate after removal of the cyst. The CTP detection test results allowed us to confirm that the small bone dehiscence was connected to the inner ear.
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Affiliation(s)
- Takeshi Fujita
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takaaki Kobayashi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuya Saito
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toru Seo
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tetsuo Ikezono
- Department of Otolaryngology, Saitama Medical University, Saitama, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
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16
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Comacchio F, Guidetti G, Guidetti R, Mion M. Pneumolabyrinth and Recurrent Paroxysmal Positional Vertigo After Traumatic Stapes Fracture. Ann Otol Rhinol Laryngol 2018; 128:352-356. [PMID: 30556403 DOI: 10.1177/0003489418819553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: The development of pneumolabyrinth without previous head trauma is a rare event; the associated symptoms may be nonspecific, and they can simulate various cochleo-vestibular pathological entities. The aim of the present study is to describe one of these rare occurrences, characterized by a peculiar onset. METHODS: We report a case of stapes fracture secondary to ear pick penetration into the middle ear with a pneumolabyrinth that caused a recurrent paroxysmal positional vertigo (PPV) mimicking a canalolithiasis. RESULTS: The patient developed a profound left sensorineural hearing loss and an intractable PPV with "migrant" features. A pneumolabyrinth was visualized with high-resolution computed tomography. A perilymphatic fistula (PLF) with stapes fracture was found while performing an explorative tympanotomy. After the surgical treatment of the PLF, the patient no longer complained of vestibular symptoms. CONCLUSIONS: To our knowledge, this is the fifth case of traumatic pneumolabyrinth simulating a canalolithiasis without previous history of temporal bone trauma and/or middle ear surgery. A pneumolabyrinth should be suspected in case of patients presenting recurrent intractable PPV after ear trauma.
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Affiliation(s)
- Francesco Comacchio
- 1 Regional Specialized Vertigo Center Veneto Region, Institute of Otolaryngology, Department of Neurosciences, Padova University, Padova, Italy
| | | | | | - Marta Mion
- 3 Institute of Otolaryngology, Department of Neurosciences, Padova University, Padova, Italy
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17
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Abstract
The inner ear, one of the most complex organs, contains within its bony shell three sensory systems, the evolutionary oldest gravity receptor system, the three semicircular canals for the detection of angular acceleration, and the auditory system--unrivaled in sensitivity and frequency discrimination. All three systems are susceptible to a host of afflictions affecting the quality of life for all of us. In the first part of this review we present an introduction to the milestones of inner ear research to pave the way for understanding the complexities of a proteomics approach to the ear. Minute sensory structures, surrounded by large fluid spaces and a hard bony shell, pose extreme challenges to the ear researcher. In spite of these obstacles, a powerful preparatory technique was developed, whereby precisely defined microscopic tissue elements can be isolated and analyzed, while maintaining the biochemical state representative of the in vivo conditions. The second part consists of a discussion of proteomics as a tool in the elucidation of basic and pathologic mechanisms, diagnosis of disease, as well as treatment. Examples are the organ of Corti proteins OCP1 and OCP2, oncomodulin, a highly specific calcium-binding protein, and several disease entities, Meniere's disease, benign paroxysmal positional vertigo, and perilymphatic fistula.
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Affiliation(s)
- I Thalmann
- Department of Otolaryngology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
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