A Study on Clinical Manifestations and Management of Traumatic Perilymphatic Fistula

A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and outside the inner ear. Perilymph leak through the communication causes cochlear and vestibular dysfunctions. PLF due to a transcanal injury, such as that caused by an earpick, is categorized as traumatic PLF. Based on the triggers, symptoms, and clinical findings, it is often easy to diagnose cases of traumatic PLF. However, in terms of treatment, the optimal timing of fistula repair surgery remains controversial. Herein, we report on 6 cases of traumatic PLF that were treated by us between April 2013 and March 2023 and discuss the clinical features and management of these cases. Earpick trauma was the cause of the traumatic PLF in all cases, and all of the cases had tympanic membrane perforation. The most frequent location (n = 4) of the tympanic membrane perforation was the posterior superior quadrant of the tympanic membrane (PSQ). In patients presenting with traumatic perforation in the PSQ, the possibility of concomitant traumatic PLF should be borne in mind, because the PSQ is close to the incudostapedial joint, through which transcanal forces may be transmitted to the inner ear. Of the 6 cases, 3 had elevated bone conduction thresholds, which improved within 2 to 4 days of fistula repair surgery in all the 3 cases. Furthermore, preoperative CT showed stapes luxation into the oval window in all the 3 cases. The present study suggests that early surgical intervention produces better hearing results in patients with traumatic PLF, especially those with elevated bone conduction thresholds and/or CT evidence of the stapes luxation into the oval window.