Cases reported "Ear Diseases"

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1/8. Perilymphatic fistula following trans-tympanic trauma: a clinical case presentation and review of the literature.

    The perilymphatic fistula is constituted by an anomalous connection between the perilymphatic space and the middle ear. The principal accuses are to be sought in the intracranial pressure increasement, cranial traumas, barotraumas, congenital anomalies, trans-tympanic traumas, etc. stapes's dislocation in the vestibule and the fracture of the platina are the most frequent pathogenic mechanisms. In clinical practice, the diagnosis remains a problem rather debated, even if the clinical pattern, the laboratory investigations, the diagnostic images and the tympanic exploration, all together can confirm, in the majority of the cases, the diagnostic suspect. This article presents a clinical case of a transtympanic trauma with perilymphatic fistula caused by a foreign body. The peculiarity of this case must be set in relation with both the aetiopathogenesis of the labyrinthine lesion and the severity of the symptomatology caused by it.
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2/8. Imaging of a congenital perilymphatic fistula.

    A 7-year-old boy with a history of purulent meningitis and watery rhinorrhea was studied using computed tomography (CT) and magnetic resonance imaging (MRI). He had a common cavity in the left inner ear. With high-resolution heavily T2-weighted MRI, leakage of the inner ear fluid into the middle ear at the oval window area through a congenital perilymphatic fistula could be visualized. Surgery to close the fistula showed a perforation in the stapes footplate.
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3/8. Traumatic perilymphatic fistula: how long can symptoms persist? A follow-up report.

    In the past 18 years 68 ears (average 3.8 per year) were explored for perilymphatic fistula (PLF). A total of nine (13%) ears had a fistula identified at operation. patients with a previous history of otologic surgery were excluded from this review. The most common etiology for PLF was head trauma (4 of 9). Most patients had persistent symptoms lasting months (average 6.7). Eighty-three percent of all patients had sudden or fluctuating hearing loss, 77 percent had vertigo or dysequilibrium, and 61 percent had tinnitus. vertigo was the most commonly improved symptom postoperatively, and only 25 percent of patients had improved hearing. There were no major complications. The authors discuss indications for operation, criteria for diagnosis of PLF, and audiometric and electronystagmographic findings. This report agrees with other recent data indicating that exploration for fistula is an uncommon procedure performed by otologists.
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4/8. Perilymphatic fistula: a new hampshire experience.

    Thirty-five patients with perilymphatic fistulas (PLFs) are presented. Of this group of 35 patients (39 ears), 4 patients did not have fistulas that could be observed with certainty but were presumed to have fistulas by virtue of their excellent response to surgical repair. Our case reports provide examples of the great variety and possible classifications of presentations and symptom complexes that lead one to suspect the diagnosis of perilymphatic fistula. Comments on diagnostic and therapeutic modalities and on postoperative care and counseling are included. The age range of patients in our series is 3 to 67 years. Four patients are under age 20, and an additional three patients probably developed their symptoms prior to age 20 but presented later. Twenty-three (79%) of 29 patients with spontaneous PLFs began having symptoms closely related to some event involving physical or mechanical stress, and a high percentage (76%) had symptoms aggravated by physical stress. Six are believed to have fistulas of congenital origin. There is a sibling pair and a mother and son in the series; these four people had bilateral fistulas.
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5/8. Preservation of hearing after removal of the membranous canal with a cholesteatoma.

    Normal cochlear function was preserved in a patient after excision of the membranous canal from a huge fistula at revision surgery eight years after the primary procedure. A recurrent cholesteatoma had eroded the entire prominence of the horizontal canal and surrounded its membranous portion. The cholesteatoma, including the membranous canal, was removed in a one-stage procedure. The open ends of the bony canal were sealed with a fascia soaked in fibrin glue. After initial dizziness and severely reduced hearing, the patient quickly recovered, with normal bone conduction and a stable 30-dB hearing level by air conduction. The lumen of the membranous canal was patent, and only the ampullar end was atretic. Presumably, the fistula became separated from fluid spaces by formation of perilymphatic partitions and by collapse of the membranous labyrinth adjacent to the fistula.
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keywords = perilymphatic
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6/8. cerebrospinal fluid otorrhea.

    Cerebrospinal fluid (CSF) otorrhea is a dangerous and potentially life threatening occurrence for which the otolaryngologist is often consulted. CSF otorrhea occurs on the basis of skull fracture, tumor, infections, congenital anomalies, and operative trauma. Forty-three patients with CSF otorrhea of varied etiology are reviewed in this paper. Eight cases are of congenital or labyrinthine origin confirming at surgery the probable connection between the subarachnoid and perilymphatic spaces. Eleven cases had spinal fluid otorrhea due to infection. All cases presented with symptoms of chronic infection: 4 cases had a history of previous surgery for chronic ear disease; 7 cases had temporal lobe abscess; 1 case had a cerebellar abscess; 8 had tegmen defects secondary to cholesteatoma; in 1 case the tegmen defect was due to previous surgery for chronic infection. Nine of 11 cases have serviceable hearing postoperatively. Fourteen cases of spinal fluid otorrhea resulted from trauma: 1 case was due to traumatic stapes footplate fracture in a congenitally malformed ear; 4 were due to transverse temporal bone fracture; and 9 were due to longitudinal temporal bone fractures. All transverse fractures resulted in nonhearing ears. Three cases were due to a combination of temporal bone fracture and infection. In 2 of these cases chronic infection preceded the fracture; in 1 case the fracture led to chronic ear disease with spinal fluid leakage. One patient required 1 surgical procedure for closure of the otorrhea, 1 patient 2 procedures, and 1 patient 3 procedures. Ten cases are due to translabyrinthine acoustic neuroma removal: 7 cases had resolution of the spinal fluid leakage after conservative nonsurgical treatment; and 3 required surgical intervention using muscle, fat and fascia obliteration of the spinal fluid pathway.
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keywords = perilymphatic
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7/8. CT cisternography in congenital perilymphatic fistula of the inner ear.

    Perilymphatic fistulas of the inner ear constitute abnormal leaks of perilymphatic fluid into the middle ear or mastoid air cell system and represent a rare cause of otorrhea. We report the case of a 5-month-old child presenting with sudden otorrhea. High resolution CT cisternography showed a malformation of the middle ear and a passage of contrast-enhanced CSF into the tympanic cavity through the left oval window. Surgery confirmed a tear of the tympanic membrane as well as a stapes malformation with aplasia of the crura and an associated perilymphatic fistula through a defect in the stapes footplate. The fistula was closed with adipose tissue from the ear lobe.
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8/8. temporal bone findings in Cogan's syndrome.

    We report on the pathological findings in temporal bones taken from a 92-year-old man who had been diagnosed as suffering from Cogan's syndrome before death. Extensive endolymphatic hydrops was observed in the cochlea of the right ear. The saccule showed a collapse following intense dilation. Outpouching of the utricle and crus commune was found and the perilymphatic space of the posterior semicircular canal was occupied by the fibrotic tissue. The left ear showed neither hydrops nor fibrosis. There was absorption of the enchondral bone in both ears, but in the blood vessels there were no pathological changes.
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