Perilymphatic fistula induced by barotrauma.

The association between diving, barotrauma, and the production of perilymphatic fistula has been known for almost 20 years. Forty-eight cases of round and oval window fistulas following diving have been reviewed and essentially corroborate previous findings. Any patient with a history of diving and subsequent sensorineural hearing loss within 72 hours should be suspected of having a round or oval window perilymphatic fistula and surgical exploration and closure of the fistula should be undertaken. Patients who have a loss of hearing, vertigo, nausea, or vomiting following a decompression dive should be re-compressed and if symptoms do not clear, exploration should be performed. Surgical treatment should be executed as soon as possible after the diagnosis is suspected for the best possible results.

Sudden hearing loss in divers and fliers.

Many papers have been written about sudden sensory hearing loss and the effect of barotrauma on the inner ear. Fistulae of the round and oval window membranes have been implicated in the great majority of these cases. It has usually been recommended that the patient be treated with conservative therapy, such as bed rest, for a period of as long as 30 days and that the final hearing results are as good or better than those that have been surgically explored and corrected. In our experience immediate surgical exploration and correction of sudden severe or profound sensorineural deafness in the diver or flier is absolutely essential and the excellent results of hearing improvement in this select group certainly corroborates this theory. Other cases with the hearing loss limited to the high frequencies most notably have tinnitus and surgical exploration does not improve the hearing but may improve vertigo if present. Numerous cases are presented to support these supositions.

The use of computerized tomography in otolaryngology.

Computed axial tomography represents a major advance in otolaryngology in the area of neuro-otology. Now that third and fourth generation scanners with their coned-down imagery are available with much better resolution, the scanner has become extremely useful in the entire field of otolaryngology. Major advantages of this technique are its noninvasive character and the absence of morbidity. This encourages its application to large numbers of patients with disorders at an early stage in the disease processes than was previously deemed prudent with other invasive diagnostic techniques. Intensive study will be necessary to develop the ultimate potential of the system fully in otolaryngology.