Abstract
Background
We evaluated the usefulness of CT and MRI for the diagnosis of perilymphatic fistula (PLF) of the round (RW) and/or oval (OW) windows, with surgery as gold standard.
Methods
We retrospectively enrolled 17 patients who presented a surgically confirmed PLF of the round (RW) or oval (OW) windows. All patients were imaged by CT + MRI (T2W SSFP without contrast) prior to surgery (= gold standard). Two radiologists, analyzed the RW and OW on the side of the clinical symptoms and sensitivity (Se) + Specificity (Sp) were calculated.
Results
Round window fistula was the most frequent (71%). The best sign of PLF on imaging was a fluid filling of the window niches, which had good Se (83–100% for RW, 66–83% for OW) and Sp (60% for RW, 91–100% for OW). Disorientation of the footplate and pneumolabyrinth were also only observed in 50% of OW PLF.
Conclusion
The combination of CT and MRI is a reliable tool for a fast and accurate diagnosis of round and oval window perilymphatic fistula, with good sensitivity (> 80%). The most common sign of PLF on imaging is the presence of a fluid-filling in the RW (especially if > 2/3 of the RW niche) or in the OW niches on both CT and MRI. A disorientation of the footplate or the presence of a pneumolabyrinth are clearly in favor of an oval window perilymphatic fistula.
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References
Al Felasi M, Pierre G, Mondain M, Uziel A, Venail F (2011) Perilymphatic fistula of the round window. Eur Ann Otorhinolaryngol Head Neck Dis 128(3):139–141
Algin O, Berçin S, Akgunduz G, Turkbey B, Cetin H (2012) Evaluation of labyrinthine fistula by MR cisternography. Emerg Radiol 19(6):557–560
Choi JE, Moon IJ, Kim H, Lee K, Cho YS, Chung WH (2017) Diagnostic criteria of barotraumatic perilymph fistula based on clinical manifestations. Acta Otolaryngol 137(1):16–22
Farrier JB (1962) Abstruce complications of stapes surgery. In: Schuknecht H (ed) International Symposium on otoslcerosis. Little Brown & Co., pp 509–521.
Alzahrani M, Fadous R, Dufour JJ, Saliba I (2015) Perilymphatic fistulas: can we predict the diagnosis? Eur Arch Otorhinolaryngol 272(8):1885–1891
Maillot O, Attyé A, Boyer E, Heck O, Kastler A, Grand S, Krainik A (2016) Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging 7(3):341–350
Herman P, Guichard JP, Van den Abbeele T, Tan CT, Bensimon JL, Marianowski R, Huy PTB (1996) Traumatic luxation of the stapes evidenced by high-resolution CT. Am J Neuroradiol 17(7):1242–1244
Lamprecht A, Morgenstern C, Lamprecht J (1985) Perilymphfisteln-Symptomatik und Indikation zur Tympanoskopie. Laryngologie Rhinologie Otologie und ihre Grenzgebiete 64(01):13–16
Maillot O, Attyé A, Boyer E, Heck O, Kastler A, Grand S, Schmerber S, Krainik A (2016) Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging. 7(3):341–350. https://doi.org/10.1007/s13244-016-0490-9(Epub 2016 Apr 16. Review. PubMed PMID: 27085885; PubMed Central PMCID: PMC4877355)
Fuse T, Tada Y, Aoyagi M, Sugai Y (1996) CT detection of facial canal dehiscence and semicircular canal fistula: comparison with surgical findings. J Comput Assist Tomogr 20(2):221–224
Pullen FW (1992) Perilymphatic fistula induced by barotrauma. Otol Neurotol 13(3):270–272
Algin O, Berçin S, Akgunduz G, Turkbey B, Cetin H (2012) Evaluation of labyrinthine fistula by MR cisternography. In: Emergency radiology. Springer.
Goodhill V (1971) Sudden deafness and round window rupture. The Laryngoscope 81(9):1462–1474. https://doi.org/10.1288/00005537-197109000-00010
Nakashima T, Sone M, Teranishi MA, Tominaga M, Sugiura M, Naganawa S (2003) Imaging of a congenital perilymphatic fistula. Int J Pediatr Otorhinolaryngol 67(4):421–425
Seltzer S, Mccabe BF (1986) Perilymph fistula: the Iowa experience. The Laryngoscope 96(1):37–49
Black FO, Lilly DJ, Nashner LM, Peterka RJ, Pesznecker SC (1987) Quantitative diagnostic test for perilymph fistulas. Otolaryngol Head Neck Surg 96(2):125–134
Singleton GT (1986) Diagnosis and treatment of perilymph fistulas without hearing loss. Otolaryngol Head Neck Surg 94(4):426–429
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In memory of Dr Dominique Rohmer.
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Venkatasamy, A., Al Ohraini, Z., Karol, A. et al. CT and MRI for the diagnosis of perilymphatic fistula: a study of 17 surgically confirmed patients. Eur Arch Otorhinolaryngol 277, 1045–1051 (2020). https://doi.org/10.1007/s00405-020-05820-3
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DOI: https://doi.org/10.1007/s00405-020-05820-3