Endoscopic Tympanic Neurectomy For Successful Treatment of Persistent Parotid Fistulas

By June 10, 2019

Kaku, Dharmistha R.1; Marfatia, Hetal1; Sharma, Arpit1; Madhvi, Asmita1; Goyal, Pankaj1
1 Department of Otorhinolaryngology, Seth G .S. Medical College, Mumbai, India.

Parotid fistula is most commonly a posttraumatic situation and can cause social embarrassment to the patient. It can be either intraductal or intraglandular. Small fistulas usually respond to conservative treatment. However tympanic neurectomy serves as an effective treatment in cases of persistent parotid fistulas and with advent of endoscopic ear surgery, it has become a very good option. Also endoscopy gives an excellent view of the anatomy of medial wall of middle ear.

To describe our experience with endoscopic tympanic neurectomy
To compare endoscopic and microscopic approach for tympanic neurectomy

Being a tertiary referral center we came across 7 cases of parotid fistulas which failed to respond to conservative approach and were treated with tympanic neurectomy. Out of these 3 cases were done using an endoscope while microscope was used for the remaining 4 cases. This Prospective study was carried out at Seth G.S.Medical College and KEM hospital, Mumbai from Jan 2017-Dec2018.

In all cases there was successful cessation of flow from parotid fistula with no recurrence or any complications on follow up. Use of endoscope helped in precise identification of the branches of Jacobson’s nerve and also helped to reduce the intraoperative time.

Endoscopic tympanic neurectomy is cost effective, minimally invasive with good therapeutic outcome. It is the best treatment modality for persistent parotid fistulas and the ends of the Jacobson’s nerve must be cauterized or drilled so as to prevent reinnervation and thereby recurrences.