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Bilateral Perilymph Fistula
N. Arsović, D. Pavlović
Institute for ENT&MFS, Clinical Center of Serbia
Hearing and Balance Center Belgrade
Controversy in otolaryngology
DusanPavlovic.com
Leak of perilymph at oval or round window No consistent symptoms No specific diagnostic test Doubtful intraoperative verification
Rome, October 19th 2015
52yr male
DusanPavlovic.com
5yr of constant disequilibrium motion intolerance pour concentration positional vertigo and history of rec. BPPV Tinnitus Two head injuries 24 and 6yr ago
Rome, October 19th 2015
Symmetrical s/n hearing loss
DusanPavlovic.com Rome, October 19th 2015
Right canal paresis
DusanPavlovic.com Rome, October 19th 2015
Normal VOR gain in all 6 canals
DusanPavlovic.com Rome, October 19th 2015
CT: susp. defect at basal plate
DusanPavlovic.com Rome, October 19th 2015
After right fistula closure
DusanPavlovic.com
patient improves a lot, but still rec. BPPV caloric test at right side improves absent oVEMP at right side (3w after surgery) cVEMP present at both sides hearing didn't change
Rome, October 19th 2015
Responce at right side improves
DusanPavlovic.com
65%
23%
Rome, October 19th 2015
6 month later, after left fistula closurepatient is without any vestibular symptoms
he starts to workhe's life completely
changed :)
65%
23%
25%
oVEMP at right side regain
DusanPavlovic.com Rome, October 19th 2015
Conclusions
DusanPavlovic.com
unstable peripheral lesion chronic disequilibrium or off balance cognitive dysfunction SST positive surgical exploration and fistula closure
Rome, October 19th 2015
Many thanks to Jeremy Hornibrook
CANVAS, David Szmulewicz
Meniere’s disease, Mohamed Hamid
Vestibular Migraine, Michael von Brevern
bbf.rs
+ 3 workshops
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