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