Fístula perilinfática de causa traumática. Reporte de un caso pediátrico / Traumatic perilymphatic fistula. Report of a pediatric case

La fístula perilinfática de causa traumática es una patología poco habitual. En general, es causada por lápices, hisopos, hebillas de pelo y fósforos.Dentro de los síntomas más frecuentes, los pacientes pueden presentar hipoacusia y vértigo. Su diagnóstico requiere un examen físico completo que incluya otomicroscopía, audiometría ytomografía computada de ambos peñascos. El tratamiento depende de la sintomatología del paciente. En general, en un principio, es conservador, pero puede llegar a requerir cirugía. Se presenta un caso clínico de un niño de 6 años con fístula perilinfática secundaria a un traumatismo del oído izquierdo por un hisopo, que requirió tratamiento quirúrgico

Traumatic perilymphatic fistula is an unusual pathology. Generally caused by pencils, swabs, hair buckles, and matches. Among the most frequent symptoms, patients can present hearing loss and vertigo.Diagnosis requires a complete physical examination that includes otomicroscopy, audiometry and computed tomography of both boulders. Treatment depends on the patient's symptoms. In general, it is conservative at first, but may require surgery.We present a clinical case of a 6-year-old boy with perilymphatic fistula secondary to left ear trauma due to swab, which required surgical treatment

Intralabyrinthine Penetrating Ventilation Tube with Preservation of Hearing: An Unusual Clinical Situation

Introduction Traumatic perilymphatic fistula is not a rare event with regards to sport activities or traffic accident. However, iatrogenic damage to the inner ear can occur following the common use of grommets and ventilation tube insertion. Objectives To report an unusual case of insertion of aeration tube into the vestibule trough the stapes footplate. Resumed Report A 62-year-old woman experienced iatrogenic penetration into the vestibule from a ventilation tube inserted for retraction pocket management. The event was misdiagnosed both by the surgeon and by the emergency room physicians, leading to delay in the management. However, preservation of the hearing function lasted for 2 weeks prior to deafness, thanks to the valve of Bast, which preserved the cochlear fluid. Conclusion This case gives us the opportunity to stress the need for systematic clinical examination of traumatic injury to the ear and to recommend performing multiplanar millimetric computed tomography scan with accurate interpretation. Traumatic injuries should be referred to a dedicated traumatic emergency referral center. .

Two Cases of Barotraumatic Perilymph Fistula Mimicking Atypical Benign Paroxysmal Positional Vertigo with Sudden Hearing Loss / 대한평형의학회지

Barotraumatic perilymph fistula is difficult to diagnose and needs diagnosis of suspicion. Symptoms like hearing loss, tinnitus, ear fullness and positional dizziness can develop following barotrauma such as valsalva, nose blowing, straining and diving, etc. We reported 2 cases of perilymph fistula following barotrauma. The patients developed hearing loss, tinnitus and ear fullness followed by sudden onset of positional dizziness mimicking benign paroxysmal positional vertigo (BPPV). On positional tests, the direction of nystagmus has changed over time. In addition, the characteristics of nystagmus on positional test were not similar to typical BPPV, which showed longer duration of nystagmus, no reversibility and no fatigability. We concluded that barotraumatic perilymph fistula could present as hearing loss with positional dizziness mimicking sudden hearing loss with BPPV. The differential diagnostic points were history of barotrauma, time sequence of development of hearing loss and positional dizziness, and atypical positional nystagmus unlike BPPV.

Critical Evaluation of Round Window Membrane Sealing in the Treatment of Idiopathic Sudden Unilateral Hearing Loss

OBJECTIVES: Rupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL. METHODS: The clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature. RESULTS: Intraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery. CONCLUSION: The results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.

A Case of Intractable Suspected Perilymph Fistula with Severe Depression

A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient's finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment.

Superior Semicircular Canal Dehiscence Syndrome Presenting with Sudden Deafness and Vertigo after Trauma / 대한평형의학회지

Superior semicircular canal dehiscence syndrome (SCDS) is characterized by cochleovestibular hyper-responsiveness symptoms including sound- and pressure-evoked vertigo and oscillopsia, autophony, hyperacusis and ear fullness. The typical audiometric feature of SCDS is known as conductive hearing loss at low frequency. A 43-year-old man presented with unilateral sudden deafness after several events of heading during soccer game. High-resolution temporal bone computed tomography revealed a dehiscence of superior canal encased by superior petrous sinus. We reviewed audio-vestibular findings in this patient and speculated potential pathogenic mechanisms of sudden deafness in SCDS with literature review.

MR score system on spatium perilymphaticum gadolinium opacification and its application for diagnosis of Meniere's disease / 中华放射学杂志

Objective To propose a MR scoring methods for spatium perilymphaticum gadolinium opacification and explore the value of their diagnosis of Meniere' s disease. Methods Fifty-one asymptomatic and 65 symptomatic patients with Meniere's disease were enrolled in this study.MR imaging ofspatium perilymphaticum after intratypanic gadolinium injection were analyzed with following scoring method.　( 1 ) Semicircular canal not visualized equal to score 0 ; some visualized equal score 1 ; full visualized equal　score 2.(2)There were high-signal and low-signal in the vestibule,low-signal areas above the lateral　semicircular canal plane equal score 6 ; low signal areas down to lateral semicircular canal plane equal score　3 ; no higher signal in the vestibule area equal score 0.( 3 ) Basal turn of cochlea:full visualized equal score　3; part visualized equal score 2; scala vestibule of basal turn smaller than scala tympani equal score　1 regardless of full or visualized in basal turn; no visualized equal score 0. Medial turn of cochlea:full　visualized equal score 2 ; part visualized equal score 1 ; no visualized equal score 0.Apical turn of cochlea:　visualized equal score 1 ; no visualized equal score 0. One radiologist scored all cases with double blind.　SPSS 17.0 software was used to conduct multiple independent-samples nonparametric tests,multivariate　Logistic regression, and ROC curve analysis. Evaluate the sensitivity and specificity for diagnosis of　Meniere's disease with the scoring system. Results ( 1 ) Meniere's disease summation score 0 to 12,median 9 (quarter spacing 4.5 ) ; no symptoms group summation score 15 to 18,median 17 (quarter spacing 3),two group differences has statistics significance (Wilcoxon rank and inspection U =-9.118,P =0.00).(2)Based on summation score for the diagnosis of Meniere's disease,tangent point was 14.5,Youden index 0.969,specificity 100.0％,sensitivity 96.9％.( 3 ) Let cochlear,vestibular,semicircular canal scoring for association variable,Logistic regression model:LogitP =61.216 - 7.381 × vestibular -3.056 × canal,based on the P value of ROC curves,diagnostic cut-off point 0.651 (vestibular ≤ 3 or semicircular canals ≤ 4 points ),Youden index 96.9％,specifisity 100.0％, sensitivity 96.9％.Conclusions Perilymphatic space of gadolinium contrast MR score in distinguishing Meniere's disease have practical value,any case meet one of following point could be diagnostic:( 1 ) Perilymphatic space of gadolinium contrast MRI total less than 14.5 ; (2) Vestibular low signal areas down more than lateral semicircular canal plane,namely vestibular score value ≤3;( 3 )Semicircular Canal scoring value ≤4.

Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

OBJECTIVES: Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF. METHODS: Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively. RESULTS: All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0+/-14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (< or =40 dB) was obtained in 4 out of 7 cases (57.1%). CONCLUSION: Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Fístula perilinfática em cobaias: comparação entre evolução natural e correção cirúrgica / Perilymphatic fistula in guinea pigs: natural evolution versus surgical treatment

As fístulas perilinfáticas ainda constituem um grande desafio quanto ao seu tratamento. Em alguns casos, seu fechamento cirúrgico pode reduzir as sequelas auditivas e vestibulares. OBJETIVO: Comparar o comportamento de fístulas perilinfáticas de janela coclear em cobaias quanto à evolução natural e fechamento cirúrgico imediato. MATERIAL E MÉTODOS: Estudo experimental. Quarenta cobaias foram submetidas à lesão da membrana da janela coclear e divididas em dois grupos aleatoriamente: fístula aberta (FA) e fístula fechada cirurgicamente (FF). Foram determinadas as amplitudes e latências do potencial de somação (PS) e do potencial de ação (PA) e da relação PS/PA em três momentos: pré-fístula (PRÉ), pós-fístula imediato (PFI) e pós-fístula tardio (PFT). RESULTADOS: Observou-se significativa queda das amplitudes e aumento das latências do PS e PA entre os momentos considerados. Quanto à relação PS/PA, houve diminuição entre PRÉ e PFI mas aumento entre PFI e PFT, ambos significantes. Não houve diferença de comportamento entre os grupos FA e FF. CONCLUSÕES: No período considerado, cobaias submetidas a lesões da membrana da janela coclear evoluíram com piora dos potenciais e latências. Apesar da melhora parcial dos parâmetros eletrofisiológicos o fechamento cirúrgico não se mostrou estatisticamente mais efetivo que a evolução natural das mesmas.

Perilymphatic fistulas still represent a major treatment challenge. In some cases, its surgical closure can reduce auditory and vestibular sequelae. AIM: to compare the behavior of cochlear window perilymphatic fistulas in guinea pigs as to their natural evolution and immediate surgical closure. MATERIALS AND METHODS: Experimental study. Forty guinea pigs were submitted to cochlear window membrane lesion and randomly broken down into two groups: open fistula (OF) and surgically closed fistula (SCF). We found the summation potential (SP) and action potential (AP) latencies and amplitudes and the SP/AP ratio at three times: pre-fistula (PRE), immediate post-fistula (IPF) and late post-fistula (LPF). RESULTS: There was a significant drop in amplitudes and raise in SP and AP latencies among the times studied. As to the SP/AP ratios, there was a reduction between PRE and IPF, both were significant. There was no behavior difference between the OF and SCF. CONCLUSIONS: Within the time frame considered, guinea pigs submitted to cochlear window membrane lesions evolved with a worsening in potentials and latencies. Despite the partial improvement in electrophysiological parameters, surgical closure did not prove statistically more effective than natural evolution.

A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion / 대한평형의학회지

This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.

The Effects of IL-1beta in Cerebrospinal Fluid on Hearing in the Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cytokines such as interleukin-1beta (IL-1beta) released into cerebrospinal fluid (CSF) during bacterial meningitis play an important role in causing inflammation and tissue damage. Bacterial meningitis is often complicated by a sensorineural hearing loss. The present study is to investigate the effect of IL-1beta injected into CSF on hearing in guinea pigs. MATERIALS AND METHODS: Thirty guinea pigs (60 ears) were randomly assigned to the following three groups: 1) Control group receiving intracisternal PBS injection. 2) 10 ng group receiving intracisternal injection of 10 ng/ml of IL-1beta. 3) 100 ng group receiving intracisternal injection of 100 ng/ml of IL-1beta. Auditory brainstem response (ABR) was performed before the injection, 10, and 24 hours after the injection of PBS and IL-1beta. The concentration of IL-1beta in the perilymph was measured in each group. RESULT: The ABR threshold shift at 10 and 24 hours were respectively 3.3+/-2.6 dB, 2.8+/-2.0 dB in the control group, 21.94+/-14.46 dB, 5.83+/-9.74 dB in the 10 ng group, and 21.58+/-15.99 dB, 4.74+/-9.05 dB in the 100 ng group. The ABR thresholds were significantly increased in the 10 and 100 ng groups compared to the control group at 10 hours, but they were not significantly different at 24 hours after the injection. The concentrations of IL-1beta in the perilymph at 10 hours were 2.17+/-0.6 ng/ml in the 10 ng group and 3.58+/-1.1 ng/m in the 100 ng group. Those were 0.53+/-0.1 ng/ml in the 10 ng and 0.86+/-0.2 ng/ml in the 100 ng groups at 24 hours after the injection. CONCLUSION: The results of this study showed that IL-1beta released into CSF during meningitis may play an important role in causing hearing loss.

Protective effect of adenosine on temporary threshold shift of audition caused by intensive white noise in guinea pigs / 第二军医大学学报

Objective: To investigate the protective effect of adenosine on hearing in acute acoustic trauma and its modulatory action in the cochlea. Methods:Guinea pigs were exposed to 118 dB SPL white noise for 30 min. During the process of exposure, artificial perilymph or artificial perilymph containing 1 mmol/L adenosine was infused into the cochlea through perilymphatic perfusion. Thresholds of compound action potentials (CAP) evoked by click and tone burst were measured before and after noise exposure. Results: Immediately after exposure, the mean threshold shifts evoked by click of the control group and adenosine treated group were (40?6.68) dB and (20?5.70) dB respectively. The threshold shifts evoked by tone burst at 2 8 kHz in the control animals were 32 50 dB, while in the adenosine treated animals, 20 35 dB. There were significant differences between the 2 groups except that at 6 kHz. Two hours after exposure, there was an increase of 4 8 dB at all frequencies in the control group; no changes in the adenosine treated group were found. There were significant differences in threshold shifts between the 2 groups at all test frequencies. Conclusion: Adenosine has protective effect on temporary threshold shift in acute acoustic trauma in guinea pigs. [

Transtympanic Endoscopic Diagnosis of Perilymph Fistula / 대한이비인후과학회지

Perilymph fistula (PLF) is a disease for which diagnostic criteria have not been established yet. For this reason, at the present time, the definitive diagnosis of PIS can only be made by direct identification of perilymphatic leak during exploratory tympanotomy. But it can be difficult to distinguish between serous transudates from operative incisions and the clear fluid expected with a true fistula. Infiltrated lidocaine makes the distinction even more difficult as well. Recently, endoscopies have been used in middle ear by transtympanic or transtubal approach. However, endoscopic diagnosis of PLF in the literature is very rare. We diagnosed 2 cases of PLF by transtympanic endoscopy. Because transtympanic endoscopy did not require lidocaine infiltration nor performing a tympanomeatal flap, confirmation of perilymphatic leakage was easier. This study therefore recommends transtympanic endoscopy as one method of improving diagnosis of PLF.

Study the Pharmacokinetics of Dexamethasone in the Perilymph after the Sodium Alginate Dexamethasone Gel Transtympanic Administration in Vivo / 听力学及言语疾病杂志

Objective To determine pharmacokinetics profiles of sodium alginate dexamethasone in perilymph after trans-round window administration of the sodium alginate dexamethasone gel in vivo.Methods 30 healthy guinea pig were randomly divided into 6 groups.Alg-Dex gel was placed into the niche of the round window of the guinea pig on the right ear.The perilymphetic samples were harvested on day 1,2,3,4 and 5 after administration of Alg-Dex gel respectively.The concentrations of dexamethasone in perilymph were assayed with high performance liquid chromatograph(HPLC).Results Concentrations of dexamethasone in perilymph on day 1,2,3,4 and 5 after administration of Alg-Dex gel were 0.49?0.06,1.32?0.28,0.65?0.08,0.66?0.05,0.53?0.17 mg/L respectively.Concentrations of dexamethasone in perilymph reached a peak on the second day and maintained 0.61?0.07 mg/L steadily on following days after administration.Conclusion Dexamethasone can be released from the sodium alginate dexamethasone gel persisitently and steadily in vivo.

Ligustrazine Hydrochloride in Blood,Cerebrospinal Fluid and Perilymph Fluid of Guinea Pig after Intramuscular Injection / 听力学及言语疾病杂志

Objective To investigate the distribution of ligustrazine hydrochloride in guinea pig blood, cerebrospinal fluid and perilymph fluid afte intramuscular injection. Methods The HPLC was used for determination of ligustrazine hydrochloride in guinea pig blood, cerebrospinal fluid and perilymph fluid afte intramuscular injection by internal and external standard method.Results Ligustrazine hydrochloride could be absorbed into blood rapidly after intramuscular administration in guinea pig. The concentration reach its high level in 20 min.It was 357.76 ?g/ml. It decreased to low level 2 h after injection.It could be found in cerebrospinal fluid 10 min after injection. The concentration reached its high level in 20 min.It was 120.50 ?g/ml.It decreased to low level 70 min after injection. The ligustrazine hydrochloride could be found in perilymph fluid 5 min later.Its high level in 20 min was 215.79 ug/ml.It decreased to low level 70 min after injection.The results indicated that ligustrazine hydrochloride was rapidly absorbed and eliminated after intramuscular administration in guinea pig.Conclusion Ligustrazine hydrochloride can be absorbed into blood, enter cerebrospinal fluid and perilymph fluid. It can pass through blood-brain barrier and blood-labyrinth barrier. The results indicates that ligustrazine hydrochloride is rapidly absorbed and eliminated after intramuscular administration in guinea pig.

Accumulation of Gentamvcin in Perilymph of Guinea Pigs / 第二军医大学学报

According to the pharmacokinetic theory, the authors studied the accumulation of gentamycin in perilymph of guinea pigs by searching the drug concentration at various time with Fluorescene Polarization Immunoassay (FPIA). The results indicated that: (1) The drug concentration in perilymph increased with the augment of total doses administered and there was almost a linear correlation between them. (2) In animals of 7-day injectious group, the drug could be still detected during 72 hours after the last dose administration. The concentration was 1 37?0.95 ?g/ml which was close to the level of serum minimal inhibitory concentration (MIC). It suggested that the elimination of the drug from inner ear was too slow and evident accumulation of gentamycin was indeed. (3) The fact mentioned above implied that the drug ototoxities could still damage the ear even if the drug administered had ceased before. It is the reason by which we could explain the problem encountered in clinic, that is why in some patients the ototoxic syndrom may still presented or enhanced even though the treatment has been stopped a few days before.

Effect of adenosine on perilymph glutamate concentration and compound action potentials in guinea pigs exposed to white noise / 第二军医大学学报

Objective:To investigate the protective effect of adenosine on cochlea in acute acoustic trauma. Methods: Guinea pigs were exposed to 118 dB SPL white noise for 30 min. During the process of exposure, artificial perilymph or artificial perilymph containing adenosine (0.1 mmol/L,1 mmol/L or 5 mmol/L) was infused into the cochlea through perilymphatic perfusion. Concentration of glutamate in perilymph and thresholds of compound action potentials (CAP) were measured before and after noise exposure. Results: After exposure, the concentration of glutamate and the mean threshold shifts evoked by click were significantly higher than those of before exposure. Concentration of glutamate and thresholds of CAP in adenosine (1 mmol/L and 5 mmol/L) treated groups were significantly lower than those of the control group. Conclusion: Adenosine can inhibit the elevation of glutamate and decrease the threshold shift of CAP after exposure to noise,which can protect cochlea in acute acoustic trauma in guinea pigs.