Comparison of endoscopic and surgical explorations for perilymphatic fistulas.

A history suggestive of perilymphatic fistula (PLF) often prompts repeated tympanostomies to establish a diagnosis and perform a repair. Two patients having multiple previous explorations for perilymphatic fistulas were reoperated, comparing endoscopic and open surgical methods. A third patient with a history consistent with PLF also underwent dual assessment. Endoscopic exploration of the middle ear was performed through a myringotomy and, immediately after, by elevation of a tympanotomy flap. The endoscopic examinations were thorough yet revealed no evidence of perilymphatic fistula; however, the surgical approaches revealed pooling in the oval windows consistent with perilymphatic fistula. These findings were video documented. Recurrent and primary fistulas may be the result of artifact, such as injected anesthetic agents and transudates introduced during surgical explorations, which may interfere with an accurate diagnosis of perilymphatic fistula. Endoscopy of the middle ear is recommended as one method to minimize errors in diagnosis.