Benefit assessment of preoperative imaging before sealing oft the round window membrane in perilymph fistula

Introduction:

An expert opinion was needed to assess whether preoperative imaging was required if perilymph fistula was suspected and sealing oft he round window was planned. In the absence of literature on this issue, a retrospective review of clinical cases to assess the benefit of preoperative imaging should be undertaken.

Methods:

The clinical data of 100 consecutive patients with tympanoscopy for acute deafness or severe hearing loss from 2010 to 2018 were analyzed. The average age was 55.9 ± 18.1 years (10.9 to 89.8 years), the gender and aspect ratio was balanced.

Results:

46% of patients had received preoperative imaging (38 CTs, 8 DVTs). Of these, in 37 cases (80%) the radiological findings showed no abnormalities, in 5 cases (11%) a non-treatment-relevant secondary finding (for example chronic sinusitis). In 4 cases (9%) "questionable" findings were found in the mastoid and/or middle ear, which were not confirmed intraoperatively in 3 cases. Only in one case, the findings of a ruptured temporal bone fracture confirmed. In this case the CT-scan was already performed in the primary diagnosis after the trauma and thus the fracture was known.

Conclusion:

The retrospective analysis of 100 cases did not provide any additional clinical benefit that would require routine screening of preoperative imaging before tympanoscopy in acute deafness. There is also no indication in the guidelines for facultative imaging with simultaneous absence of clinical hints for previous operations, chronic inflammation or malformations. Secondary 55% of the patients received a cMRT to exclude an acoustic neurinoma or similiar of central processes after the mentioned treatment.

Publication History

Publication Date:
23 April 2019 (online)