Post-traumatic perilymphatic fistulas have been described following ear and
temporal bone injury, particularly in the setting of temporal bone fractur
es. However, indications for exploratory surgery in cases of trauma without
temporal bone fracture are vague and not well described. We describe three
children who presented with symptoms suggestive of perilymphatic fistula (
PLF) without an associated temporal bone fracture: two with penetrating tym
panic membrane injuries and one with blunt temporal bone trauma. All had sy
mptoms of hearing loss and vestibular disturbance. Two of the children coop
erated with ear-specific audiologic assessment, which demonstrated sensorin
eural hearing loss (SNHL) on the traumatized side. The third child showed a
udiometric evidence of a SNHL on the injured side, but due to his age, the
degree of severity of the SNHL was unable to be appropriately addressed pri
or to the patient being surgically managed. All three children underwent ex
ploratory surgery and were found to have bony defects in the region of the
oval window. All were repaired with fascial grafts to the oval and round wi
ndows with complete resolution of vestibular symptoms. However, two of the
three patients with documented post-operative audiograms suffered from pers
istent SNHL on the injured side. We conclude that exploratory middle ear su
rgery is indicated in patients suffering from blunt or penetrating temporal
bone or middle ear trauma who demonstrate persistent vestibular symptoms,
sensorineural hearing loss or radiographic evidence of oval window patholog
y. As this is a limited number of patients, a larger series may be warrante
d to study the actual incidence of post-traumatic PLF in the child with per
sistent hearing loss and vertigo after head or ear trauma. (C) 2001 Elsevie
r Science Ireland Ltd. All rights reserved.