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History Stations
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Have you been exposed to any loud sounds or any recent head trauma? (A perilymph fistula should be considered if there is a history of pressure changes and sudden hearing loss associated with a positive fistula test [nystagmus when applying manual pressure to the ipsilateral tragus].)
History Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
Have you been exposed to any loud sounds or any recent head trauma? (A perilymph fistula should be considered if there is a history of pressure changes and sudden hearing loss associated with a positive fistula test [nystagmus when applying manual pressure to the ipsilateral tragus].)
Ear, nose and throat
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Inner ear barotrauma (e.g. from excessive Valsalva manoeuvre) may cause perilymph fistula with sudden onset of vertigo with an accompanying hearing loss and tinnitus; management may be conservative or surgical; flying not usually permitted until resolution.
Inner ear test battery in guinea pig models – a review
Published in Acta Oto-Laryngologica, 2018
Based on the explosive and implosive routes for round window membrane rupture, two methods were employed to establish the animal model of perilymph fistula (PLF). One was rupturing the round window membrane by elevating CSF pressure via injecting artificial perilymph into the subarachnoid space. The other was performed by suctioning 4 µL of perilymph via the round window membrane. Both methods demonstrated similar pathological findings in guinea pigs, yet establishing the animal model of PLF by the suction method is much simpler than that by the injection method [10]. One week after operation, caloric test revealed various responses such as caloric areflexia, caloric irregularity, and normal caloric responses, correlating with different clinical features in patients with PLF. Morphological study also demonstrated different histopathological findings, i.e. vestibular atelectasis, floating labyrinth, or normal contour of the membranous labyrinth. The vestibular atelectasis (collapse of membranous labyrinth) was correlated with caloric areflexia, while the floating labyrinth was related to irregular caloric responses [10]. These different pathophysiological results may explain why various clinical manifestations in PLF patients. Follow-up study revealed that resolution of caloric response progressed from canal paresis via caloric irregularity to a final return of normal caloric responses in some guinea pigs with a healed PLF (Figure 3).
Paul Green (1951-2020): A Tribute
Published in Developmental Neuropsychology, 2020
Roger O. Gervais, Lloyd Flaro, David E. Hartman, Martin L. Rohling
Paul began investigating symptom validity testing after he came upon an article on the “perilymph fistula syndrome” (PFS; Grimm, Hemenway, Lebray, & Black, 1989). These PFS patients displayed symptom patterns we would now describe as persistent PCS symptoms and he wondered, at the time, whether PFS explained other peculiar cases, e.g., whiplash, mTBI, etc. The first author remembers Paul marching clients up and down the hallway doing the drunk walk with eyes closed, standing on one leg, etc., checking for vestibular issues. But sometime around 1992–93, when Paul returned from NAN with the CARB, which examined digit memory validity, he was astounded to find up to 40% of his cases failing this very easy test. That was the end of the perilymph fistula hypothesis.
Contemporary review of the causes and differential diagnosis of sudden sensorineural hearing loss
Published in International Journal of Audiology, 2020
For perilymph fistula, many cases that initially appeared to be MD have been subsequently shown to be perilymph fistula at exploratory tympanotomy, probably because endolymphatic hydrops (EH) can be induced by a perilymph fistula based on a series of animal experiments (Nomura and Hara 1986; Nomura et al. 1992). Spontaneous nystagmus, positional nystagmus, or abnormal caloric responses may aid in the differential diagnosis of perilymph fistula from MD (Young, Nomura, and Hara 1992). Recently, early exploratory tympanotomy with special attention to the bony region, anterior to the oval window has proven helpful to confirm a fissula ante fenestram fistula in cases of SSHL (Tóth et al. 2016).