Perilymph fistula - 45 case analysis

Purpose of the study: Though perilymph fistula (PLF) is not a rare disease, preoperative diagnosis still remains to be established. Some new diagnosti c methods are challenging, but there is still no established diagnostic met hod except exploratory tympanotomy that verifies the occurrence of leakage. Early diagnosis of PLF is fully depending on history taking and some clini cal examinations. To know the clinical features of PLF is one of the greate st helps to make both earlier and accurate diagnosis. In spite of some inno vations in clinical examinations classic diagnostic procedure is thought to be still reliable. Procedures: We investigated the clinical symptoms, basi c tests results and therapeutic results in patients with PLF. Results: From 1983 to 1998 PLF was identified in 44 patients (45 ears) with exploratory tympanotomies in our hospital. With respect to clinical history the predisp osing factors such as blowing the nose, lifting heavy goods, and landing in an airplane were found in almost half of the patients, while the rest of t hem had no clear inducing factors. Their major symptoms included hearing lo ss (93%), vertigo and dizziness (91%), tinnitus (76%), and aural fullness ( 31%). The patients who have a clear predisposing factor tended to make diag nosis easily; on the other hand the rest of the patients who do not have cl ear etiology had some diagnostic difficulty. Subjective positive fistula si gns were observed in 71% of patients. Vestibular symptoms improved in 80% o f patients after closure of PLF. Conclusions: These results suggest that th e variety of clinical manifestation make diagnosis more difficult. At the m oment meticulous clinical history taking and close follow-up applying repea ting fistula tests are the most important for not only earlier but also acc urate diagnosis. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved .