A Case of Sensorineural Hearing Loss and Vertigo during Epidural Nerve Block / 대한평형의학회지

Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness, and hearing loss can occur suddenly. We report a 65-year-old woman who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.

A Case of Perilymphatic Fistula Misdiagnosed as Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Perilymphatic fistula (PLF) is an uncommon disease characterized by abnormal leakage of the perilymph from the inner ear into the middle ear. The symptoms of PLF include sudden-onset hearing loss, tinnitus, ear fullness, and vertigo resulting from inner-ear trauma, stapedial surgery or barotrauma such as valsalva, and nose blowing. As nystagmus can be induced by the affected-ear in down position, benign positional paroxysmal vertigo (BPPV) should be considered for differential diagnosis. About 40-50% of PLF patients have experienced spontaneous healing, but surgical repair should be considered when the hearing symptom and dizziness are not alleviated or are aggravated within a few days. Reported herein, with a review of the relevant literature, is a case of PLF initially misdiagnosed as BPPV but where successful fistula repair was finally achieved.

Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.

Delayed Positional Vertigo after Stapes Surgery / 대한평형의학회지

Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.

A Case of Repair Using Hydroxyapatite Cement for Recurrent Perilymphatic Fistulas Occurred at Round Window After Cholesteatoma Surgery / 대한이비인후과학회지

Perilymphatic fistula (PLF) is a rare condition characterized by abnormal leakage of perilymph from the inner ear into the middle ear via a defect in the oval or round windows. PLF needs special attention concerning early diagnosis and treatment, because it can cause dizziness, hearing loss, tinnitus, meningitis, and other symptoms. The diagnosis of PLF usually cannot be confirmed before exploratory tympanotomy. Fascia, perichondrium, loose areolar tissue, fat and gelfoam can be used effectively in the PLF repair. Fibrin glue was used to aid in securing the graft material. However, recurrence is not rare and revision is sometimes needed to relieve the symptoms associated with the leakage of perilymph. So otologic surgeons should keep in mind that PLF has a great tendency to recur. Careful surgical procedures together with strict postoperative management are important to prevent recurrence and hydroxyapatite cement (HAC) can be used to cover the fistula area as a alternative graft material in recurrent perilymphatic fistula. We report on one recurrent case of postoperative PLF occurring at the round window that was repaired with HAC.

Pneumolabyrinth Resulting from Trauma: Report of Two Cases / 대한이비인후과학회지

Pneumolabyrinth is an uncommon condition in which air bubbles in the labyrinth are described, although its underlying pathophysiology is still not widely understood. It may be associated with barotrauma, stapedial surgery, cochlear implantation, head trauma, and temporal bone fracture. When it occurs, it is ususally identified on high-resolution computed tomography of the temporal bone and an early surgical intervention leads to a more rapid resolution of vestibular symptoms and preservation of existing auditory function. Recently, the authors have experienced two cases of pneumolabyrinth resulting from trauma. Hence, we report two cases with a review of literature.

Traumatic Perilymphatic Fistula Presenting with Direction-Changing Positional Nystagmus

Diagnosis of perilymphatic fistula (PLF) is considered in the patient presenting hearing loss associated with ataxia after penetrating injury of the tympanic membrane. PLF accompanies mixed type hearing loss and paralytic nystagmus. If audiovestibular symptoms and signs are not definite for those patients, in whom PLF is highly suspicious, they can be induced by affected ear down position. The direction of nystagmus induced by position change was reported either toward or away from the affected ear. But the direction changing nature has not been noted in the previous literature. We report on a case of traumatic PLF presented with direction changing positional nystagmus and discuss the possible mechanism involved in this case

Effects of Round Window Membrane Rupture on Morphological Changes of Guinea Pig's Cochlea / 听力学及言语疾病杂志

Objective Clinical reports on perilymphatic fistulae(PLF) of the round window membrane(RWM) have shown different degrees of hearing loss. For the unknown mechanisms of hearing loss, the morphological changes of cochlea with perilymphatic fistulae(PLF) was studied.Methods Among 10 guinea pigs, each ear on one side was punctured and the ear of another side was used as control. 4 hours after operation, the morphological changes of cochlea were observed.Results It was found that 2 ears with endolymphatic hydrops, 1 ear with strica vascularis stripped, venous hyperemia and hemorrhage in cochlea, 7 ears with no changes.Conclusion The study suggestes that the normal and the abnormal morphological changes of cochlea can all be seen after the rupture of RWM.