Peculiarities of clinical manifestations of perilymphatic fistulas and evaluation of the effectiveness of treatment in patients with middle ear cholesteatoma

By the analysis of the 410 histories of illnesses of patients in 38 (9,26 %) are set perilymphatic fistula of different localization. Clinical, radiological intraoperative differences and going are set near the choice of method reconstructively operation depending on the type of perilymphatic fistula. After motion the extensive is certain more aggressive perilymphatic fistula is widespread, especially in the cases of cholesteatoma destruction of bone wall of labyrinth and simultaneous adhesion with a membranous labyrinth. On the stage of preoperative diagnostics from data of КТ of temporal bones of perilymphatic fistula set for 21 (55,3 %) patients and determined almost for all patients with extensive widespread perilymphatic fistula (in 12 patients from 13) and in 9 patients with limit perilymphatic fistula. By the preoperative inspection the positive test of fistula was determined only in 7 % patients. After localization more often perilymphatic fistula was determined at the level of lateral semicircular canal – for 23 patients (60,5 %). Plural localization of perilymphatic fistula with the united defeat of bone wall two and more semicircular canals educed 5 patients (13,1 %). The open variant of tympanoplasty is executed in 30 patients (78,9 %). The closed variant of tympanoplasty is in 6 (15,8 %) patients. Early exposure of perilymphatic fistula after the presence of not staggered endost and in good time reconstructive surgical interference is conducted with optimal combined by microscopically-endoscopic visualization for patients with chronic otitis media with cholesteatome will allow saving a rumor and will prevent development of irreversible complications from the side of internal ear.

Significance of Pseudo-conductive Hearing Loss and Positional Nystagmus on Perilymphatic Fistula: Are they related to third window effects?

Objectives. Clinical presentation is critical to identify suspected perilymphatic fistula (PLF). To explain characteristic of PLF, it was hypothesized that a third window lesion might be involved in the pathomechanism. The purpose of this study is to investigate clinical features in PLF and figure out the relationship of third window effect and PLF. Methods. Sixty patients underwent surgical exploration under suspicion of PLF and reinforecmenet of oval window and round window was performed. Clinical features including demographics, pure tone audiometry (PTA), and videonystagmography (VNG) were evaluated preoperatively and 1 month after operation. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap (ABG)) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, the postoperative subjective dizziness was assessed by interview in clinic. The change of positional nystagmus was analyzed according to ABG closure and hearing improvement.Results. ABG at lower frequencies (LFABG, 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, the PTA was significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). The subjective dizziness improved in 56 patients (91.8%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, the positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 (64.7%) patients. Conclusions. Pseudo-conductive hearing loss at the lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the RW and OW improved hearing threshold accompanied by closure of ABG. The third window lesion might explain these clinical features that indicate PLF.

New method of surgical treatment of patients with congenital oval window aplasia

Aplasia of the oval window is an extremely rare developmental anomaly of the middle ear. Previously, many authors proposed various methods of surgical treatment of this pathology, but in most cases it was not possible to achieve a stable satisfactory functional result. At this stage, an idea was formed about the main reason for the unsatisfactory results, namely, the overgrowth of the formed vestibulostomy, which is accompanied by fixation of the prosthesis. The solution of this problem is one of the priority tasks of surgery for malformations of the middle ear at this stage. This paper presents a new developed and patented method of surgical treatment of patients with congenital aplasia of the vestibule window. The method consists in modeling a complex titanium prosthesis, consisting of an f-element and an m-element. The f-element is installed in the neo-oval window and has the function of a protector that prevents fixation of the prosthesis as a result of bone-cicatricial obliteration processes. Further, the plunger part of the f-element is installed in the m-element. The developed method of stapes prosthetics in case of anomalies in the development of the vestibule window, based on the results of this study, has proven its high efficiency. Installation of a modified endo-lymphatic shunt into the formed neo-oval window, pressing the fascial flap previously placed on the neo-oval window, followed by the insertion of the K-piston prosthesis, prevents overgrowing of the neo-oval window in the postoperative period, prevents the development of fixation of the prosthesis and prevents the development of perilymphatic fistula. A comparative assessment of the effectiveness of the proposed method and method with the formation of a neo-oval window and the installation of a stapedial prosthesis (as in piston stapedoplasty) was carried out. The effectiveness of the developed method has been proven – 89% of the functional efficiency in the long-term postoperative period, which is close to the indicators of the effectiveness of piston stapedoplasty in otosclerosis (the frequency of a stable satisfactory functional result when performing piston stapedoplasty in otosclerosis is about 95%).

Complete Restored Hearing Loss after Excessive Nose Blowing with Various CT Findings

A perilymphatic fistula (PLF) is defined as leakage of perilymph with several possible causes such as superior canal dehiscence through trauma, temporal bone fracture, or sudden pressure change (e.g., skydiving or scuba diving). Pneumolabyrinth can result from temporal bone fracture after trauma, or sudden pressure change in the middle ear or cerebrospinal fluid, such as excessive nose blowing or Valsalva maneuver. A PLF and pneumolabyrinth may occur without trauma, associated with a sudden pressure change in the middle ear. We report two cases of PLF followed by pneumolabyrinth and one case of suspicious PLF without pneumolabyrinth after excessive nose blowing. All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment. We report various CT findings of pneumolabyrinth and PLF, from normal CT findings to air pockets in the labyrinth and soft tissue density around the stapes.