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1.
Surg Radiol Anat ; 43(2): 225-229, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33111218

ABSTRACT

BACKGROUND AND PURPOSE: Preoperative prediction of cerebrospinal fluid (CSF) gusher is important for stapes surgery. According to the current opinion settled among otologists and radiologists, the issues of whether enlarged cochlear aqueduct might be a cause of CSF gusher in stapes surgery and which segment of the aqueduct should be taken into account to diagnose enlarged cochlear aqueduct in computerized tomography (CT) are controversial. The case we encountered led us to hypothesize that enlarged cochlear aqueduct might cause CSF gusher in stapes surgery and that shape and diameter of medial aperture of the cochlear aqueduct are important in this prediction. METHODS AND RESULTS: Enlarged medial aperture of the cochlear aqueduct with a shape differed from that of the other side was retrospectively diagnosed in thin-slice CT in a patient who had been undergone middle ear and stapes surgery for conductive hearing loss. This finding went unnoticed in preoperative CT. In the small fenestra stapedotomy operation, CSF gusher occurred through opening in the ill-defined, fixed and thickened stapes footplate. A piece of temporalis fascia and reshaped incus were appropriately placed which stopped the gusher. Re-evaluation of preoperatively taken CT showed that anterior-posterior and superior-inferior diameters of the medial aperture were 11.7 mm and 2.87 mm in CSF gusher side versus 2.95 mm and 1.88 mm on the other side, respectively. Its shape in gusher side differed from that of the other side. CONCLUSION: This report is the first to show video-documented CSF gusher in a patient with enlarged medial aperture of the cochlear aqueduct. It appears to be plausible to propose that these findings have to change the otologists' and radiologists' perspective to the cochlear aqueduct. It can be deduced that difference in shapes of the medial aperture in both sides might be an indicator of potential CSF gusher.


Subject(s)
Cerebrospinal Fluid Otorrhea/etiology , Cochlear Aqueduct/abnormalities , Intraoperative Complications/etiology , Stapes Surgery/adverse effects , Cerebrospinal Fluid Otorrhea/diagnosis , Cochlear Aqueduct/diagnostic imaging , Cochlear Aqueduct/injuries , Humans , Intraoperative Complications/diagnosis , Male , Preoperative Period , Tomography, X-Ray Computed , Young Adult
2.
Diving Hyperb Med ; 46(2): 72-5, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27334993

ABSTRACT

INTRODUCTION: Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula. METHODS: We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment. RESULTS: Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12). CONCLUSION: The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early.


Subject(s)
Barotrauma/complications , Cochlear Aqueduct/injuries , Cochlear Diseases/etiology , Diving/injuries , Fistula/etiology , Adult , Aged , Cochlear Diseases/diagnosis , Cochlear Diseases/surgery , Deafness/etiology , Dizziness/etiology , Fistula/diagnosis , Fistula/surgery , Humans , Male , Middle Aged , Tinnitus/etiology , Young Adult
3.
Eur Ann Otorhinolaryngol Head Neck Dis ; 130(5): 283-7, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23759282

ABSTRACT

INTRODUCTION: Temporal bone fracture is a common complication of high-energy cranial trauma. Labyrinth involvement is rare, but there is a risk of perilymphatic rupture that is often underestimated on initial clinical examination due to the predominance of neurological and/or somatic symptoms. CASE REPORT: A patient presented with overlooked perilymphatic fistula, decompensated by hyperpressure effort due to poorly adapted management. DISCUSSION: Following a review of the literature on post-traumatic pneumolabyrinth, overall management (from diagnosis to treatment, via prevention advice) was analyzed. A constructive critique of the patient's treatment was thus made. CONCLUSION: We argue for a systematic management protocol in cranial trauma with temporal bone fracture, comprising ENT examination, millimetric-scale cross-sectional imaging of the fracture site, and standardized counseling to prevent late complications.


Subject(s)
Air , Cochlear Aqueduct/injuries , Cochlear Diseases/complications , Cochlear Diseases/diagnosis , Emergencies , Fistula/complications , Fistula/diagnosis , Labyrinth Diseases/etiology , Perilymph , Skull Fractures/complications , Temporal Bone/injuries , Wounds, Nonpenetrating/complications , Adult , Cochlear Aqueduct/surgery , Cochlear Diseases/surgery , Delayed Diagnosis , Fistula/surgery , Hearing Loss, Sudden/etiology , Humans , Labyrinth Diseases/surgery , Male , Mandibular Fractures/complications , Mandibular Fractures/diagnosis , Mandibular Fractures/surgery , Meniere Disease/etiology , Radiographic Image Enhancement , Radiographic Magnification , Skull Fractures/diagnosis , Skull Fractures/surgery , Stapes/injuries , Tinnitus/etiology , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/surgery
4.
Laryngoscope ; 121(4): 856-9, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21305555

ABSTRACT

A perilymphatic fistula (PLF) is an abnormal communication between the inner and middle ear resulting in vestibular or cochlear symptoms. We review three pediatric traumatic temporal bone fractures with pneumolabyrinth, confirmed radiologically by the presence of air within the cochlea (pneumocochlea) or vestibule (pneumovestibule). Patients were treated conservatively with complete resolution of vestibulopathy. Hearing outcome was variable and worse in two patients with pneumocochlea. A pneumolabyrinth on radiologic imaging confirms a PLF and obviates the need for exploration to reach a diagnosis. We suggest exploration be reserved for patients with persisting cerebrospinal fluid leakage, progressive sensorineural hearing loss, or vestibular symptomatology.


Subject(s)
Air , Athletic Injuries/complications , Bicycling/injuries , Cochlear Aqueduct/injuries , Cochlear Diseases/diagnosis , Ear, Middle/injuries , Fistula/diagnosis , Football/injuries , Frontal Bone/injuries , Head Injuries, Closed/complications , Labyrinth Diseases/diagnosis , Skull Fractures/complications , Temporal Bone/injuries , Wounds, Nonpenetrating/complications , Adolescent , Athletic Injuries/diagnosis , Child , Child, Preschool , Cochlear Diseases/rehabilitation , Deafness/diagnosis , Deafness/etiology , Deafness/rehabilitation , Fistula/rehabilitation , Follow-Up Studies , Head Injuries, Closed/diagnosis , Humans , Image Processing, Computer-Assisted , Labyrinth Diseases/rehabilitation , Male , Skull Fractures/diagnosis , Tomography, Spiral Computed , Vestibule, Labyrinth/injuries , Wounds, Nonpenetrating/rehabilitation
5.
Otol Neurotol ; 27(8): 1193-6, 2006 Dec.
Article in English | MEDLINE | ID: mdl-16983314

ABSTRACT

OBJECTIVE: To present two cases of recurrent diving-related inner ear barotrauma (IEB) and to discuss the possible cause and pathogenesis of the increased inner ear vulnerability. STUDY DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Two scuba divers suffering from repeated cochleovestibular barotrauma. INTERVENTIONS: Neurotological evaluation, perilymphatic fistulae repair, and conservative treatment. MAIN OUTCOME MEASURE: The increasing popularity of scuba diving expose the individuals involved in this sport to unique pathologies that are not common under terrestrial conditions. The otolaryngologist who is involved in the care of these patients is required to diagnose and treat diving-related ear injuries and to consider the risk for recurrent inner ear injury when diving is resumed. CONCLUSION: IEB carries a risk for permanent hearing loss and chronic vestibulopathy. We recommend complete neurotological evaluation including high-resolution CT of the temporal bones as a routine workup for IEB. The presence of a significant residual sensorineural hearing loss, evidence for noncompensated vestibular damage, and CT findings of possible enhanced cerebrospinal fluid-perilymph connection should be considered when a return to diving activity is considered.


Subject(s)
Barotrauma/etiology , Diving/adverse effects , Ear, Inner/injuries , Hearing Loss, Sensorineural/etiology , Adult , Barotrauma/physiopathology , Cochlear Aqueduct/injuries , Cochlear Aqueduct/pathology , Ear, Inner/pathology , Eustachian Tube/injuries , Eustachian Tube/pathology , Female , Humans , Male , Recurrence , Tinnitus/etiology , Tomography, X-Ray Computed , Vertigo/etiology
6.
Am J Otol ; 8(4): 313-8, 1987 Jul.
Article in English | MEDLINE | ID: mdl-3631238

ABSTRACT

In three patients with perilymphatic fistula, exploratory tympanotomy revealed air bubbles emerging through the ruptured round window membrane. Review of the literature disclosed three case reports in which air was demonstrated in the labyrinth in association with perilymphatic fistula. Experimental evidence that air could enter the labyrinth through a defect of the round window membrane was described in two articles. In our patients, the perilymphatic fistula was produced by implosive force. When a perilymphatic fistula was produced by implosive force, or in the case of a pre-existing perilymphatic fistula, we assume, air may enter the scala tympani through the defect of the round window membrane if the middle ear pressure rises beyond a certain limit. Sudden onset of deafness and reversibility of hearing in perilymphatic fistula could be attributable to the presence of air bubble in the scala tympani--pneumolabyrinth--which might disturb propagation of the traveling wave of the basilar membrane.


Subject(s)
Cochlea , Cochlear Aqueduct , Emphysema/etiology , Fistula/etiology , Adolescent , Child , Cochlea/injuries , Cochlea/surgery , Cochlear Aqueduct/injuries , Cochlear Aqueduct/surgery , Emphysema/complications , Emphysema/diagnosis , Emphysema/surgery , Female , Fistula/complications , Fistula/diagnosis , Fistula/surgery , Hearing Disorders/etiology , Humans , Labyrinth Diseases/complications , Labyrinth Diseases/diagnosis , Labyrinth Diseases/etiology , Labyrinth Diseases/surgery , Male , Middle Aged , Round Window, Ear/injuries , Round Window, Ear/surgery , Rupture , Scala Tympani/injuries , Scala Tympani/surgery , Tinnitus/etiology
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