[Validation of a clinical scale for the diagnosis of perilymphatic fistula]

INTRODUCTION

The diagnosis of perilymphatic fistula (PLF) is difficult because no single clinical situation gives the diagnosis for sure. The goal of this article is to study the clinical situations where you must suspect a PLF and to support a clinical scale described in a previous work (Bussières et al 2003).

METHODS

Retrospective study of 15 patients that had an exploratory tympanotomy with a PLF not confirmed preoperatively. An analysis of the symptoms, signs and complementary exams were done. The surgical technique and findings and the postoperative evolution were noted.

RESULTS

There is 66.7% of hypoacusis the most frequently symptom (postoperative improvement of 26.7%); after came vertigo present in 60% (postoperative improvement of 44.4%) and tinnitus present in 53.3% (postoperative improvement of 25%). The trauma history is always positive, most of then is typical (80%) and the other one are atypical (20%).The diagnosis of PLF has been determined in 5 patients in the follow-up according to the improvement of the symptoms. These patients had a score > 7 at the clinical scale.

CONCLUSION

The sensibility and specificity scores of the clinical scale are respectively 100% and 70% in this study.

[When to suspect a perilymphatic fistula?]

INTRODUCTION

The diagnosis of perilymphatic fistula (PLF) is difficult since no single clinical situation gives the diagnosis for sure. The goal of this study is to clarify the clinical situations where you must suspect a PLF.

METHODS

Retrospective study of 20 patients that had an exploratory tympanotomy with a PLF confirmed peroperatively. An analysis of the symptoms, signs and complementary exams was done. The surgical findings and the postoperative evolution were noted.

RESULTS

100% of patients reported a hearing loss, 80% vertigo, 70% a tinnitus and 35% equilibrium problems. Every patient had an etiological event to explain the PLF (trauma 85%), stapedotomy (10%), other ear surgeries. Five patients had a positive fistula or Vasalva test. All patients except one had an hearing loss on the audiogram (sensorineural, mixte or conductive). 50% had a CT scan, 70% of which were abnormal. A VNG was done on 3 patients. The sites of the PLF were as follows: 90% oval window, 5% round window and 5% both windows. The hearing got better or was stabilised in 95% of patients after the operation. 64% saw an improvement of their tinnitus and 87% of their vertigo.

CONCLUSION

The diagnosis of PLF is difficult and a high index of suspicion is mandatory. One must look for an etiologic situation to explain the PLF. The audiogram is almost always modified, a mixte hearing loss being common due to the high incidence of ossicular trauma associated with PLF. The clinical clinical situations where you must suspect a PLF were identified as follows: An old trauma, a recent trauma, a history of otologic surgery particularly on the stapes and a preexisting hearing loss that aggravates. A diagnosis scale to evaluate the risk of PLF, based on clinical situations, physical exam and complementary exams was done to help the clinician in the evaluation of PLF.

[History of the rehabilitation of the deaf child]

As a deaf mute, because mute and more often than not deaf, and then deaf and dumb, because deaf and therefore dumb, the deaf child inevitably deprived of spontaneous speech was considered up to the end of the middle ages as having no possibility of language or of thought, left to the sorry fate of being part of a sporadic population expressing themselves by gestures, a language bereft of past and future, understood only by a few members of the family or occasionally deaf neighbours. During the Renaissance, it appeared that with specific education the deaf child could talk, have a language, and therefore thought. Due merit must be given to 16th century Spain. In the 18th century, France discovered that gestures can also be a language, collated and constructed thanks to the collaboration of the partially deaf. From then on, gestual language flourished in America whilst the rest of Europe continued to prefer oral rehabilitation. With current medical progress, the deaf are no longer deaf. Deafness in the child still exists, however, but there are no longer any mutes. The deaf child can achieve access to language, which may be oral or gestual. The choice between these two modes of expression is still very tropical.