Perilymphatic fistula in children with preexisting sensorineural hearing loss.
Progression of preexisting sensorineural hearing loss (SNHL) in infants and children has been considered an indication for fistula exploration: is this approach warranted? On exploring 36 middle ears in 26 such children, we found a perilymphatic fistula (PLF) in four ears (11%). Although there was radiographic evidence of inner-ear deformity in one half of these children, a definite fistula was found in only four of 18 radiographically abnormal ears explored (22%). Even in the four patients with a history of an "event" that could implicate a fistula such as exertion or barotrauma, a fistula was found in only one. There are a number of possible causes for progression of a preexisting SNHL, and surgical exploration of the middle ear should not be recommended on the basis of progression alone. Instead, exploration for a suspected PLF should be strongly considered when there is also a history of an "event", and/or radiographic evidence of inner-ear abnormalities. Even under these conditions, one should be aware that fistulae are not likely to be found.
Pappas
D G
DG
Division of Otology, University of Alabama, School of Medicine, Birmingham.
Simpson
L C
LC
Godwin
G H
GH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle / Q000601:surgery; D005260:Female; D005402:Fistula / Q000150:complications* / Q000209:etiology / Q000601:surgery; D006319:Hearing Loss, Sensorineural / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007761:Labyrinthine Fluids; D008297:Male; D010498:Perilymph; D013701:Temporal Bone / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed