Round window rupture. Detection by fluorescence endoscopy

Rupture of the round window membrane as a special cause of inner ear deafne ss is widely accepted after changing pressure levels, e.g. in diving. Howev er, even without a barotrauma before, the spontaneous rupture of the round window membrane is suspected occasionally in patients with sudden hearing l oss and/or vertigo and tinnitus. To carry through the tympanotomy is decide d by ENT surgeons often in cases of progressive hearing loss despite infusi on therapy. Perilymph fistulas have been detected relatively seldom, compar ed to the number of reported operations by several authors. However, coveri ng the round niche with connective tissue leads to the improvement of sympt oms sometimes even in cases without microscopical evidence of fistula. Within the last 3 years 14 patients suffering sudden hearing loss of one ea r underwent tympanotomy in our departement. Of these patients 8 reached res titution of the hearing ability. Especially 2 patients with sudden deafness caused by spontaneous rupture of the round window membrane are reported in the following article. Perilymph fistulas were detected in these cases by IV-application of fluorescein and fluorescence endoscopy of the middle ear. Both patients obtained a normal hearing curve within 1 week after surgical intervention and obliteration of the round niche.