1/41. Traces of perilymph detected in epipharyngeal fluid: perilymphatic fistula as a cause of sudden hearing loss diagnosed with beta-trace protein (prostaglandin D synthase) immunoelectrophoresis.The incidence of perilymphatic fistula as cause of sudden hearing loss is not known. We present a case with sudden unilateral hearing loss associated with a positive beta-trace protein test of an epipharyngeal fluid sample. The patient presented with sudden sensorineural hearing loss on the right side. A stapedotomy had been performed nine months previously due to otosclerosis. Intravenous therapy for the treatment of sudden hearing loss was unsuccessful. At the time of sudden hearing loss, epipharyngeal fluid was collected using a Raucocel sinus pack. Investigation using rocket immunoelectrophoresis showed the presence of beta-trace protein. Upon repeating tympanoscopy there was no obvious labyrinthine fluid egress, but the oval window was sealed with fibrin sponge and fibrin glue. The patient's hearing improved over a period of five months.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/41. Endoscope-guided round window fistula repair.OBJECTIVE: Endoscope-guided round window membrane repair was performed to evaluate whether the approach is feasible in the treatment of a round window fistula. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care academic center. PATIENT: A 27-year-old man had been scuba diving 6 days previously in the Australian Great Barrier Reefs. He had poor hearing with tinnitus in the left ear and a vertiginous sensation. INTERVENTION: A myringotomy was incised, and a tympanoscope was introduced into the middle ear cavity. With the patient under general anesthesia, the middle ear and the oval and round window areas were examined with a tympanoscope. In endoscopic visualization, a round perforation could be seen in the round window membrane. After detection of the round window perforation, a small piece of temporal fascia was obtained to seal the membrane perforation. RESULTS: One month after the operation, the patient's hearing was significantly better. The myringotomy had healed. CONCLUSION: A transmyringeal endoscopic procedure for round window fistula repair is feasible and combines the best features of minimally invasive surgery and aural endoscopy.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
3/41. recurrence of pneumococcal meningitis due to primary spontaneous cerebrospinal fluid fistulas.The authors report a case of pneumococcal meningitis which recurred 3 times in a Taiwanese boy due to spontaneous cerebrospinal fluid (CSF) fistulas. The first time occurred at the age of 2 years, and the second episode presented as meningoencephalomyelitis at the age of 6 years 10 months. Studies including serum levels of immunoglobulin and complements, brain magnetic resonance imaging, and coronal cranial computed tomography (CT) were negative for a specific etiology. The third episode of meningitis developed 2 months after the second episode. Repeated immunological studies and high-resolution CT of paranasal sinuses and temporal bones were negative. technetium-99m diethylenetriamine pentaacetic acid (Tc-99m-DTPA) radionuclide cisternography revealed abnormal retention of radioactivity over the right mastoid area. neurosurgery was undertaken to seal the dural tear and pack the petrosal fissure. Two years after surgery, he has had no further CSF leak age or meningitis. Tracing back the history, there was no head injury, cranial surgery, brain tumor, or hydrocephalus, which might have created CSF fistulas. Primary spontaneous CSF fistulas constitute the most reasonable diagnosis. In cases of recurrent bacterial meningitis, underlying anatomic defects should be carefully evaluated if there is no immune defect.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
4/41. The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea.Repair of fistulas producing cerebrospinal fluid rhinorrhea, as with any reconstructive operations, should take into account the basic principles of reconstructive surgery for best results: 1. tissue needing replacement should be replaced by like tissue; and 2. a flap is always superior to a graft. In the case of this disease, the tissue sealing the fistula should be a flap containing not only mucosa or mucoperiosteum, but also pedicled bone. Two kinds of regional flaps are described which successfully closed the fistula in each of three patients. Follow-up is long term.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/41. Repair of inadvertent conjunctival filtering blebs with a scleral flap.We describe a new technique to correct inadvertent conjunctival filtering blebs. This method creates a partial-thickness scleral flap to seal the region of the excised fistula. Closure of this flap with sutures permanently covers the fistula and eliminates any route for recurrence of the bleb or downgrowth of epithelium. No complications have been associated with this procedure, which has been used in more than 10 cases during the last 3 years.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
6/41. Penetrating wounds of the ear with oval window fistulas. Reports of 2 cases.In 2 patients with penetrating wounds of the ear lesions involved the tympanic membrane and the ossicular chain. The long process of the incus was lying on the fallopian canal and the stapes was deeply depressed into the vestibule. In spite of a large oval window fistula, cochleovestibular signs were minimal. The fistula was sealed with adipose tissue and the stapes replaced by a Teflon-platinum piston prosthesis. The incus was repositioned and supported by a fat graft placed between the fallopian canal and the long process. This original technique of reconstructing the ossicular chain gave satisfactory functional results in both patients.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/41. Recurrent meningitis and a congenital perilymph fistula.In any child with recurrent meningitis, the presence of a congenital perilymph fistula must be entertained. All of the patients must have an audiologic assessment, and if a sensorineural loss is demonstrated, CT of the temporal bones should be performed. CT is excellent in identifying malformations within the temporal bones, fistulous tracts, soft tissue densities in the middle ear, and defects in the tegmen tympani. Although MRI may provide superior discrimination of the audiovestibular and facial nerves and cerebellopontine angle, presently it does not offer any distinct advantages over CT in evaluation of the inner ear. When a fistula is suspected, an exploratory tympanotomy is recommended, and any CSF leak is sealed with muscle.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/41. Endoscopic fibrin sealing of congenital pyriform sinus fistula.pyriform sinus fistula is a very rare branchial apparatus malformation, often appearing in the form of a cervical inflammatory process (abscess or suppurative thyroiditis), especially in infants. Failure to diagnose this lesion may result in unexpected recurrence. A case of recurrent suppurative thyroiditis caused by pyriform sinus fistula in a 9-year-old girl is reported. In the latency period of infection, the fistula tract was identified by a barium meal contrast study. Direct endoscopy showed the fistula internal orifice at the apex of the left pyriform fossa. The fistula was completely obliterated by injection of fibrin glue. Suppurative thyroiditis is reported mainly in the pediatric literature, and the reported case is the first to be managed endoscopically by injection of fibrin adhesive.- - - - - - - - - - ranking = 4keywords = seal (Clic here for more details about this article) |
9/41. Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report.STUDY DESIGN: A case of cerebrospinal fistula secondary to a dural tear during anterior cervical discectomy and fusion. OBJECTIVES: To report a quite rare complication associated with anterior cervical discectomy and remind the spinal surgeons that this infrequent complication can easily become a very serious one. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy represents one of the most commonly performed spinal procedures. Of the associated complications, accidental dural tear can lead to the development of a cerebrospinal fluid (CSF) fistula. Although this complication has been mentioned in several clinical series, the body of knowledge regarding incidence and appropriate treatment is definitely limited. methods: After undergoing anterior cervical discectomy and fusion for an extruded disc at the C4-C5 level, a CSF fistula developed in a 37-year-old patient as a result of a dural tear. The patient underwent a second procedure for surgical wound revision, meticulous dural opening coverage, and insertion of a lumbar drain for draining CSF for 5 days. RESULTS: The patient was hospitalized for 5 days and then discharged with no evidence of CSF leakage. His follow-up of 9 months revealed complete resolution of his preoperative symptomatology and no other problems associated with the complication of the CSF fistula. CONCLUSION: Early identification of this complication and aggressive treatment with insertion of lumbar drain, CSF drainage for 4-5 days, and coverage of the dural tear with fibrin sealant or autologous fascia graft can prevent the development of any consequences.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/41. Occult otologic fistulas as a cause of recurrent meningitis.OBJECTIVE: Occult perilymph fistulas may be the cause of unexplained non-epidemic meningitis. MATERIAL AND METHOD: To review the case reports of 5 patients (3 females and 2 males aged 4-56) presenting with unexplained meningitis. All had sensorineural hearing loss of variable duration. RESULTS: All patients were submitted to CT, MRI and MRI cisternography. All underwent exploratory tympanotomy to seal the fistula. In all patients the fistula could be located and sealed. All had no further attacks of meningitis and those who had serviceable hearing did not show any further deterioration. CONCLUSION: In any case of recurrent meningitis an occult perilymph leak should be sought. A high degree of suspicion should exist if there are auditory or vestibular symptoms. Detecting and sealing of the defect will protect the patient against further attacks and deterioration of hearing.- - - - - - - - - - ranking = 3keywords = seal (Clic here for more details about this article) |
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