Rawal, Rounak1,2; Zhao, Xue1,2; Brodsky, Jacob1,2
1 Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA;
2 Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
Introduction:
Traumatic perilymphatic fistula (PLF) is an uncommon cause of acute vestibular symptoms and hearing loss following head injury in children. We describe our experience with management of three pediatric cases of traumatic PLF using a totally endoscopic ear surgery (TEES) approach.
Methods:
Three pediatric cases of traumatic PLF that were repaired via a TEES approach over a three month period between August and October 2018 were reviewed. Patients included a 14 month-old male, 13 year-old male, and 14 year-old female. All patients underwent endoscopic middle ear exploration and PLF repair with tragal perichondrium promptly following initial evaluation, which occurred within hours post-injury in two patients, while the third was initially seen 15 months post-injury in our outpatient pediatric vestibular clinic.
Discussion:
PLF was identified from the round window, oval window, and both in each case, respectively. Both patients with oval window PLF also had ossicular injuries that were repaired. The 14 month old patient had a particularly brisk leak in the setting of a patent Hyrtl’s fissue, which required a second stage surgery via a post-auricular, endoscope-assisted approach with the aid of a lumbar drain to achieve definitive repair. All patients had complete resolution of vestibular symptoms post-operatively with no signs of PLF recurrence at a mean follow-up duration of 4 months.
Conclusions:
Traumatic PLF can be safely and effectively managed by a TEES approach in children, though the feasibility of this approach may be limited in very small children and with higher volume leaks.