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CT and MRI for the diagnosis of perilymphatic fistula: a study of 17 surgically confirmed patients

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Abstract

Background

We evaluated the usefulness of CT and MRI for the diagnosis of perilymphatic fistula (PLF) of the round (RW) and/or oval (OW) windows, with surgery as gold standard.

Methods

We retrospectively enrolled 17 patients who presented a surgically confirmed PLF of the round (RW) or oval (OW) windows. All patients were imaged by CT + MRI (T2W SSFP without contrast) prior to surgery (= gold standard). Two radiologists, analyzed the RW and OW on the side of the clinical symptoms and sensitivity (Se) + Specificity (Sp) were calculated.

Results

Round window fistula was the most frequent (71%). The best sign of PLF on imaging was a fluid filling of the window niches, which had good Se (83–100% for RW, 66–83% for OW) and Sp (60% for RW, 91–100% for OW). Disorientation of the footplate and pneumolabyrinth were also only observed in 50% of OW PLF.

Conclusion

The combination of CT and MRI is a reliable tool for a fast and accurate diagnosis of round and oval window perilymphatic fistula, with good sensitivity (> 80%). The most common sign of PLF on imaging is the presence of a fluid-filling in the RW (especially if > 2/3 of the RW niche) or in the OW niches on both CT and MRI. A disorientation of the footplate or the presence of a pneumolabyrinth are clearly in favor of an oval window perilymphatic fistula.

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Acknowledgments

In memory of Dr Dominique Rohmer.

Funding

No funding was received for this study.

Author information

Correspondence to Aïna Venkatasamy.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of our institution, approval number FC/dossier 2017-34) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Venkatasamy, A., Al Ohraini, Z., Karol, A. et al. CT and MRI for the diagnosis of perilymphatic fistula: a study of 17 surgically confirmed patients. Eur Arch Otorhinolaryngol (2020). https://doi.org/10.1007/s00405-020-05820-3

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Keywords

  • MRI
  • CT
  • Middle ear
  • Fistula
  • Perilymph