title: Surgical management of perilymphatic fistulas: a Portland experience.
abstract: A comprehensive review of our series of surgical perilymphatic fistula (PLF) repairs, as well as a review of published results from other otologists, suggested an unacceptably high rate of postoperative PLF recurrence. Some recurrences were related to specific events (i.e., coughing, strenuous activity, Valsalva-type maneuvers). However many cases had no apparent cause. Rather, the patients' symptoms recurred spontaneously, and at reoperation the graft was seen to have not "taken," suggesting graft failure rather than "patient failure." After a critical evaluation of current PLF surgical procedures and state-of-the-art concepts of wound healing, we developed a new surgical technique for PLF closure. Combining the use of laser graft-site preparation, an autologous fibrin glue "buttress," and a program of postoperative activity restriction, the new procedure allowed us to achieve statistically significant improvements in graft retention and surgical outcome, with recurrences dropping from 27 percent to 8 percent. In addition, complete resolution or significant symptomatic improvement occurred in 89 percent of patients with vertigo and/or dizziness and in 84 percent with disequilibrium. We conclude that this new surgical technique is an important addition to the otologic surgeon's arsenal for PLF management.
authors.affiliation: Department of Neurotology, Good Samaritan Hospital and Medical Center, Portland, Oregon 97210.
authors.forename: F O
authors.initials: FO
authors.lastname: Black
authors.forename: S
authors.initials: S
authors.lastname: Pesznecker
authors.forename: T
authors.initials: T
authors.lastname: Norton
authors.forename: L
authors.initials: L
authors.lastname: Fowler
authors.forename: D J
authors.initials: DJ
authors.lastname: Lilly
authors.forename: C
authors.initials: C
authors.lastname: Shupert
authors.forename: W G
authors.initials: WG
authors.lastname: Hemenway
authors.forename: R J
authors.initials: RJ
authors.lastname: Peterka
authors.forename: E S
authors.initials: ES
authors.lastname: Jacobson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005402:Fistula / Q000601:surgery*; D006319:Hearing Loss, Sensorineural / Q000601:surgery; D006801:Humans; D007759:Labyrinth Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010046:Oval Window, Ear / Q000601:surgery; D010498:Perilymph; D012008:Recurrence; D012086:Reoperation; D012405:Round Window, Ear / Q000601:surgery