Surgical management of perilymphatic fistulas

A Portland experience

F. O. Black, S. Pesznecker, T. Norton, L. Fowler, D. J. Lilly, C. Shupert, W. G. Hemenway, Robert (Bob) Peterka, E. S. Jacobson

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

A comprehensive review of our series of surgical perilymphatic fistula (PLF) repairs, as well as a review of published results from other otologists, suggested an unacceptably high rate of postoperative PLF recurrence. Some recurrences were related to specific events (i.e., coughing, strenuous activity, Valsalva-type maneuvers). However many cases had no apparent cause. Rather, the patients' symptoms recurred spontaneously, and at reoperation the graft was seen to have not 'taken,' suggesting graft failure rather than 'patient failure.' After a critical evaluation of current PLF surgical procedures and state-of-the-art concepts of wound healing, we developed a new surgical technique for PLF closure. Combining the use of lasergraft-site preparation, an autologous fibrin glue 'buttress,' and a program of postoperative activity restriction, the new procedure allowed us to achieve statistically significant improvements in graft retention and surgical outcome, with recurrences dropping from 27 percent to 8 percent. In addition, complete resolution or significant symptomatic improvement occurred in 89 percent of patients with vertigo and/or dizziness and in 84 percent with disequilibrium. We conclude that this new surgical techique is an important addition to the otologic surgeon's arsenal for PLF management.

Original languageEnglish (US)
Pages (from-to)254-262
Number of pages9
JournalAmerican Journal of Otology
Volume13
Issue number3
StatePublished - 1992
Externally publishedYes

Fingerprint

Fistula
Transplants
Recurrence
Valsalva Maneuver
Fibrin Tissue Adhesive
Vertigo
Dizziness
Reoperation
Wound Healing

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Black, F. O., Pesznecker, S., Norton, T., Fowler, L., Lilly, D. J., Shupert, C., ... Jacobson, E. S. (1992). Surgical management of perilymphatic fistulas: A Portland experience. American Journal of Otology, 13(3), 254-262.

Surgical management of perilymphatic fistulas : A Portland experience. / Black, F. O.; Pesznecker, S.; Norton, T.; Fowler, L.; Lilly, D. J.; Shupert, C.; Hemenway, W. G.; Peterka, Robert (Bob); Jacobson, E. S.

In: American Journal of Otology, Vol. 13, No. 3, 1992, p. 254-262.

Research output: Contribution to journalArticle

Black, FO, Pesznecker, S, Norton, T, Fowler, L, Lilly, DJ, Shupert, C, Hemenway, WG, Peterka, RB & Jacobson, ES 1992, 'Surgical management of perilymphatic fistulas: A Portland experience', American Journal of Otology, vol. 13, no. 3, pp. 254-262.
Black FO, Pesznecker S, Norton T, Fowler L, Lilly DJ, Shupert C et al. Surgical management of perilymphatic fistulas: A Portland experience. American Journal of Otology. 1992;13(3):254-262.
Black, F. O. ; Pesznecker, S. ; Norton, T. ; Fowler, L. ; Lilly, D. J. ; Shupert, C. ; Hemenway, W. G. ; Peterka, Robert (Bob) ; Jacobson, E. S. / Surgical management of perilymphatic fistulas : A Portland experience. In: American Journal of Otology. 1992 ; Vol. 13, No. 3. pp. 254-262.
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