Otolaryngology Houston
Bechara Y. Ghorayeb, MD
8830 Long Point, Suite 806
Houston, Texas 77055
Tel. 713 464 2614
This page was last updated: August 9, 2010
Perilymph Fistula - Middle Ear Exploration
Ten years ago, this middle aged woman had a tympanoplasty and ossicular chain reconstruction with a TORP. Since then, she has been suffering from chronic vertigo, imbalance, nausea and occasional vomiting. There was a significant conductive hearing loss. The middle ear was explored. A displaced TORP was removed and a perilymph fistula was discovered in the oval window. Apparently, the stapes had been completely removed; even the footplate was absent and the oval window was just covered with fibrous scar tissue.
The above pathology is depicted in a movie clip that shows perilymph leaking from under the fibrous membrane that covers the oval window. The fistula was then sealed with temporalis fascia and a new titanium TORP was placed over the fascia. Hearing improved postoperatively.
A displaced TORP is seen protruding through the right tympanic membrane.
Higher magnification of the above photo. Note the scarring of the tympanic membrane.
A tympanomeatal flap is reflected anteriorly to open the middle ear. The TORP is pulled out with an alligator forceps.
