Cited by 33Vestibular and auditory disordersEar Surgery and Otitis MediaNeurosurgical Procedures and Complications

The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index; none of the 22 sources its claims cite is checked for support yet.

Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

Open access
Park, Ga Young, Byun, HaYoung, Moon, Il Joon, Hong, Sung Hwa, Cho, Yang-Sun, Chung, Won-Ho·2012·Clinical and Experimental Otorhinolaryngology

Abstract

OBJECTIVES: Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF. METHODS: Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively. RESULTS: All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0±14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (≤40 dB) was obtained in 4 out of 7 cases (57.1%). CONCLUSION: Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In nine patients (10 ears) with suspected barotraumatic perilymph fistula, early surgical exploration was followed by immediate resolution of dizziness in all patients and a mean hearing gain of 27.0 ± 14.9 dB. The authors recommend early surgical exploration for sudden or progressive sensorineural hearing loss with dizziness after barotrauma.

Key findings

  • All 9 patients (10 cases) had sudden or progressive hearing loss and dizziness after barotrauma; vestibular symptoms disappeared immediately after surgery in every patient.
  • Mean hearing gain was 27.0 ± 14.9 dB (range, 10–55 dB), and serviceable hearing (≤40 dB) was achieved in 5 of 10 cases (50%).
  • When surgery was performed <10 days after trauma, serviceable hearing was obtained in 4 of 7 cases (57.1%), compared with 1 of 3 cases (33.3%) after 10 days.
  • Intraoperative possible evidence of perilymph fistula was found in 9 cases: fibrous web around the oval window (n=3), fluid collection in the round window (n=6), and bulging of the round window pseudomembrane (n=1).

Methods

  • Retrospective review of medical records of 9 patients who underwent exploratory tympanotomy from January 2005 through December 2010 with clinical impression of barotraumatic perilymph fistula.
  • Types of antecedent trauma, operative findings, postoperative dizziness, hearing outcomes, and time interval between trauma and surgery were assessed; pure tone averages at 0.5, 1, 2, and 4 kHz were compared at 2 months after surgery.
  • Surgical exploration exposed the oval and round windows; both windows were covered with soft tissue and fibrin glue whether or not a suspected fistula site was found.

Limitations

  • The paper states that conclusions about optimal timing for improved hearing outcomes could not be determined because of the limited number of cases.
  • The paper states that, because of the limited number of cases and lack of a control group, the effects of conservative management could not be exactly ruled out.
  • Evident from the text: this is a small, single-center retrospective case series without a definite diagnostic test for perilymph fistula, and surgery was performed within two days of first visit at the authors’ center despite trauma-to-surgery intervals of 2 to 47 days.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3342/ceo.2012.5.2.74

Cites

12 of 12 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Standard surgical techniques of perilymph fistulas repair. (A) Soft tissue was covered over the oval window and stapes (arrow). (B) Soft tissue was covered over the round window (arrow). (C) Fibrin glue was applied in the middle ear cavity (arrow).
Fig. 1 Standard surgical techniques of perilymph fistulas repair. (A) Soft tissue was covered over the oval window and stapes (arrow). (B) Soft tissue was covered over the round window (arrow). (C) Fibrin glue was applied in the middle ear cavity (arrow).CC BY-NC · PubMed Central
Fig. 2 Pre- and postoperative audiograms of nine patients (A-I). Preoperatively, down-sloping configurations of audiograms were common. Air bone gap, especially in low frequency (250, 500, and 1,000 Hz), was found in 5 cases (A, B, E-G). Postoperatively, the mean hearing gain was 27.0±14.9 dB, especially at lower frequency and postoperative hearing improved to serviceable level (≤40 dB) in 5 out of 10 cases (A, C, D, F, I). Air bone gap was closed postoperatively.
Fig. 2 Pre- and postoperative audiograms of nine patients (A-I). Preoperatively, down-sloping configurations of audiograms were common. Air bone gap, especially in low frequency (250, 500, and 1,000 Hz), was found in 5 cases (A, B, E-G). Postoperatively, the mean hearing gain was 27.0±14.9 dB, especially at lower frequency and postoperative hearing improved to serviceable level (≤40 dB) in 5 out of 10 cases (A, C, D, F, I). Air bone gap was closed postoperatively.CC BY-NC · PubMed Central
Fig. 3 Various findings during exploratory tympanotomy of patients with suspected perilymph fistulas. (A) Fluid collection in the right round window (RW) niche. (B) Fibrous web around right stapes and oval window (OW). (C) Fibrous web around right RW.
Fig. 3 Various findings during exploratory tympanotomy of patients with suspected perilymph fistulas. (A) Fluid collection in the right round window (RW) niche. (B) Fibrous web around right stapes and oval window (OW). (C) Fibrous web around right RW.CC BY-NC · PubMed Central
Fig. 4 Hearing outcomes analyzed according to the time interval between the trauma and the surgical repair. Two patients (case C and D, empty circle) showed serviceable hearing before the operation.
Fig. 4 Hearing outcomes analyzed according to the time interval between the trauma and the surgical repair. Two patients (case C and D, empty circle) showed serviceable hearing before the operation.CC BY-NC · PubMed Central
Fig. 5 Pre- and postoperative hearing results. Postoperatively, the mean hearing gain was 27.0±14.9 dB. If surgery was done before 10 days after surgery (case A-F, solid line), serviceable hearing was achieved in 4 out of 7 (57.1%) compared to 1 out of 3 (33.3%) after 10 days after surgery (case G-I, dotted line).
Fig. 5 Pre- and postoperative hearing results. Postoperatively, the mean hearing gain was 27.0±14.9 dB. If surgery was done before 10 days after surgery (case A-F, solid line), serviceable hearing was achieved in 4 out of 7 (57.1%) compared to 1 out of 3 (33.3%) after 10 days after surgery (case G-I, dotted line).CC BY-NC · PubMed Central

Verification

Claims the paper makes

20 Own result · 14 Own interpretation · 7 No full text of the sources · 3 Not checked yet · 2 Sources not found · 2 Own method

Verify all 3 references — free account

Show all 29 claims

  • Probably not a substantial claim. 12
  • It may state two separate claims as one. 13
19 of 19
  • The paper relies on this without support.

    The patients clinically suspected of barotraumatic PLF actually had a perilymph fistula.

    “The medical records of nine patients that underwent exploratory tympanotomy from January 2005 through December 2010, with the clinical impression of a barotraumatic PLF, were reviewed.”
  • The paper relies on this without support.

    The observed postoperative improvements in hearing and dizziness are due to surgical repair rather than natural recovery or conservative management.

    “In our series, because of limited number of cases and lacking a control group we could not exactly rule out the effects of conservative management.”
  • The paper relies on this without support.

    Surgical exploration under local anesthesia has low morbidity and usually takes less than an hour.

    “In addition, surgical exploration under local anesthesia has low morbidity and usually takes less than an hour.”
  • The paper relies on this without support.

    Severe traumatic head injury causing temporal bone fracture and pneumolabyrinth usually causes permanent deafness and total vestibular loss immediately after head trauma.

    “Severe traumatic head injury to cause the temporal bone fracture and pneu­ molabyrinth were not included. Because these type of injury usually cause permanent deafness and total vestibular loss immediately after head trauma.”
  • The paper relies on this without support.

    The diagnosis of traumatic PLF is mostly based on clinical findings, including history, physical examination and audiogram.

    “The diagnosis of traumatic PLF is mostly based on the clinical findings, including the history , physical examination and audiogram.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

5 of 5

Citations

Cites

Show all 12 references

Research works printed but not linked: 3

  1. Glasscock, 1992, Am J Otol, 13, 333
  2. Black, 1992, Am J Otol, 13, 254
  3. Simmons, 1982, Adv Otorhinolaryngol, 28, 68

Cited by

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Metadata

Authors
Park, G. Y., Byun, H., Moon, I. J., Hong, S. H., Cho, Y.-S., & Chung, W.-H.
Affiliations
Samsung Medical Center (KR)
Corresponding author
Chung, Won-Ho
Venue
Clinical and Experimental Otorhinolaryngology
Published
2012
Volume
5
Issue
2
Pages
74
ISSN
  • 1976-8710 (ISSN-L)
  • 2005-0720
OpenAlex
W1964998496
Cited by
33
References
12
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 6 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 1
FWCI
0.56
Type
journal article
Language
en
Open access
Locations
  • Clinical and Experimental Otorhinolaryngology (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by-nc)
  • PubMed Central (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Otorhinolaryngology › Ear Surgery and Otitis Media
  • Health Sciences › Medicine › Clinical Neurology › Neurosurgical Procedures and Complications
Keywords
perilymphatic fistula, barotrauma, early surgical exploration, sudden sensorineural hearing loss, dizziness, round window, oval window, hearing outcomes, timing of surgery, vestibular symptoms

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