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Idiopathic Perilymphatic Fistulas: A Temporal Bone Histopathologic Study With Clinical, Surgical, and Histopathologic Correlations

Idiopathic Perilymphatic Fistulas: A Temporal Bone Histopathologic Study With Clinical, Surgical,... Abstract Objective: To report a case of idiopathic perilymphatic fistulas diagnosed and successfully treated during life and confirmed histopathologically post mortem. Methods: Perilymphatic fistulas were diagnosed clinically and repaired surgically. Light microscopic histopathologic studies were made of both temporal bones after death. Results: Vestibular symptoms had improved postoperatively. Postmortem histopathologic examination of the temporal bones demonstrated patencies of the labyrinth capsule that had been predicted clinically during life, the qualities of the membranous labyrinth in both the operated-on and the unoperated-on ears, and the elements of the surgical repair. Notably, there was no evidence of endolymphatic hydrops. Conclusions: The histopathologic findings document the relationships of the fistula ante fenestram and the fissure connecting the round window niche and the posterior semicircular canal to idiopathic perilymphatic fistulas. Also, the diagnostic features reported herein allowed this patient with fluctuating hearing loss, episodic vertigo, and tinnitus to be distinguished from a patient with Meniere's syndrome. These findings have implications regarding past and future studies of vestibular and cochlear disorders.(Arch Otolaryngol Head Neck Surg. 1995;121:412-420) References 1. Kohut RI, Hinojosa R, Budetti JA. Perilymphatic fistula: a histopathologic study . Ann Otol Rhinol Laryngol . 1986;95:466-471. 2. Kohut RI, Hinojosa R, Ryu JH. Perilymphatic fistulae: a single-blind clinical histopathologic study . In: Pirodda E, ed. Advances in Otorhinolaryngology . Basel, Switzerland S Karger AG; 1988; 42:148-152. 3. Wolf G. Autogenous fibrin glue in tympanoplasty . Am J Otol . 1986;7:287-288. 4. Bloom W, Fawcett DW. A Textbook of Histology . 9th ed. Philadelphia, Pa: WB Saunders Co; 1968. 5. Kohut RI, Hinojosa R, Ryu JH. A temporal bone study method to evaluate clinical diagnostic criteria: permeability of patencies of the fissula ante fenestram . Otol Head Neck Surg . 1991;104:143-144. 6. Bast TH. Ossification of the otic capsule in human fetuses . Carnegie Contrib Embryol . 1930; 121:53-82. 7. Bast TH. Development of the otic capsule, II: the origin, development and significance of the fissula ante fenestram and its relation to otosclerotic foci . Arch Otolaryngol . 1933;18:1-20.Crossref 8. Anson BJ, Martin J Jr. Fissula ante fenestram: its form and contents in early life . Arch Otolaryngol . 1935;21:303-323.Crossref 9. Anson BJ, Cauldwell EW. Stapes, fissula ante fenestram and associated structures in man, IV: from fetuses 75 to 100 mm. in length . Arch Otolaryngol . 1943;37:650-671.Crossref 10. Okano Y, Myers EN. Herniation of the singular nerve into the round window niche . Arch Otolaryngol . 1976;102:478-481.Crossref 11. Okano Y, Myers EN, Dickson DR. Microfissure between the round window niche and posterior canal ampulla . Ann Otol Rhinol Laryngol . 1977; 86:49-57. 12. Kohut RI. Perilymphatic fistulae . In: Bailey BJ, ed. Head and Neck Surgery: Otolaryngology . Philadelphia, Pa: JB Lippincott; 1993:1702-1710. 13. Nadol JB Jr. Positive 'fistula sign' with an intact tympanic membrane: clinical report of three cases and histopathological description of vestibulofibrosis as the probable cause . Arch Otolaryngol . 1974;100:273-278.Crossref 14. Nadol JB Jr. Positive Hennebert's sign in Meniere's disease . Arch Otolaryngol . 1977;103:524-530.Crossref 15. Bárány R. Diagnose von Krankheitsercheinungen im Bereiche des Otolithenapparates . Acta Otolaryngol (Stockh) . 1921;2:434-437.Crossref 16. Schuknecht H. Cupulolithiasis . Arch Otolaryngol . 1969;90:765-778.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Idiopathic Perilymphatic Fistulas: A Temporal Bone Histopathologic Study With Clinical, Surgical, and Histopathologic Correlations

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1995.01890040036006
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To report a case of idiopathic perilymphatic fistulas diagnosed and successfully treated during life and confirmed histopathologically post mortem. Methods: Perilymphatic fistulas were diagnosed clinically and repaired surgically. Light microscopic histopathologic studies were made of both temporal bones after death. Results: Vestibular symptoms had improved postoperatively. Postmortem histopathologic examination of the temporal bones demonstrated patencies of the labyrinth capsule that had been predicted clinically during life, the qualities of the membranous labyrinth in both the operated-on and the unoperated-on ears, and the elements of the surgical repair. Notably, there was no evidence of endolymphatic hydrops. Conclusions: The histopathologic findings document the relationships of the fistula ante fenestram and the fissure connecting the round window niche and the posterior semicircular canal to idiopathic perilymphatic fistulas. Also, the diagnostic features reported herein allowed this patient with fluctuating hearing loss, episodic vertigo, and tinnitus to be distinguished from a patient with Meniere's syndrome. These findings have implications regarding past and future studies of vestibular and cochlear disorders.(Arch Otolaryngol Head Neck Surg. 1995;121:412-420) References 1. Kohut RI, Hinojosa R, Budetti JA. Perilymphatic fistula: a histopathologic study . Ann Otol Rhinol Laryngol . 1986;95:466-471. 2. Kohut RI, Hinojosa R, Ryu JH. Perilymphatic fistulae: a single-blind clinical histopathologic study . In: Pirodda E, ed. Advances in Otorhinolaryngology . Basel, Switzerland S Karger AG; 1988; 42:148-152. 3. Wolf G. Autogenous fibrin glue in tympanoplasty . Am J Otol . 1986;7:287-288. 4. Bloom W, Fawcett DW. A Textbook of Histology . 9th ed. Philadelphia, Pa: WB Saunders Co; 1968. 5. Kohut RI, Hinojosa R, Ryu JH. A temporal bone study method to evaluate clinical diagnostic criteria: permeability of patencies of the fissula ante fenestram . Otol Head Neck Surg . 1991;104:143-144. 6. Bast TH. Ossification of the otic capsule in human fetuses . Carnegie Contrib Embryol . 1930; 121:53-82. 7. Bast TH. Development of the otic capsule, II: the origin, development and significance of the fissula ante fenestram and its relation to otosclerotic foci . Arch Otolaryngol . 1933;18:1-20.Crossref 8. Anson BJ, Martin J Jr. Fissula ante fenestram: its form and contents in early life . Arch Otolaryngol . 1935;21:303-323.Crossref 9. Anson BJ, Cauldwell EW. Stapes, fissula ante fenestram and associated structures in man, IV: from fetuses 75 to 100 mm. in length . Arch Otolaryngol . 1943;37:650-671.Crossref 10. Okano Y, Myers EN. Herniation of the singular nerve into the round window niche . Arch Otolaryngol . 1976;102:478-481.Crossref 11. Okano Y, Myers EN, Dickson DR. Microfissure between the round window niche and posterior canal ampulla . Ann Otol Rhinol Laryngol . 1977; 86:49-57. 12. Kohut RI. Perilymphatic fistulae . In: Bailey BJ, ed. Head and Neck Surgery: Otolaryngology . Philadelphia, Pa: JB Lippincott; 1993:1702-1710. 13. Nadol JB Jr. Positive 'fistula sign' with an intact tympanic membrane: clinical report of three cases and histopathological description of vestibulofibrosis as the probable cause . Arch Otolaryngol . 1974;100:273-278.Crossref 14. Nadol JB Jr. Positive Hennebert's sign in Meniere's disease . Arch Otolaryngol . 1977;103:524-530.Crossref 15. Bárány R. Diagnose von Krankheitsercheinungen im Bereiche des Otolithenapparates . Acta Otolaryngol (Stockh) . 1921;2:434-437.Crossref 16. Schuknecht H. Cupulolithiasis . Arch Otolaryngol . 1969;90:765-778.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Apr 1, 1995

References

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