A case of traumatic perilymphatic fistula caused by ceramic columella, due to the pressure of a replacement tampon

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Other Title
  • 術後タンポン交換によりApaceram-T®が前庭窓嵌入を来たした症例
  • ─TORPによる底板損傷─

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Description

This paper reports a case of traumatic perilymphatic fistula induced by a ceramic TORP due to the pressure of a tampon for replacement on the tympanum. A 68-year-old female presented to our hospital with conductive hearing loss, and central tympanic membrane perforation and calcification were identified. Tympanotomy revealed calcification around the stapes and stapedial fixation. The stapes was not surgically treated in consideration of the possible occurrence of internal otitis due to poor hygiene in the tympanic cavity, while the incus was conserved for secondary stapes surgery in the case of recurrent stapedial fixation. After slightly mobilizing the footplate of the stapes, the ossicular chain was reconstructed by connecting the footplate and malleus using a ceramic TORP. On postoperative day 19, severe vertigo and hearing loss were observed in the presence of a left-beating nystagmus when a tampon for replacement was pressed on the tympanum; on temporal bone CT scanning, it was shown that the axis of the TORP intruded into the vestibular window. On the same day, exploratory tympanotomy was performed to confirm the displacement of the footplate and intrusion of the TORP axis into the vestibular window. Perilymph leakage from the oval window was also observed. Therefore, the incus was removed for the dissection of granulomatous lesions after surgery, while the tympanum was connected with the oval window using the TORP after removing its axis and closing the oval window with the fascia. On the next day, although no vertigo was observed, hearing had not recovered to the previous level.

Journal

  • Otology Japan

    Otology Japan 23 (1), 35-39, 2013

    Japan Otological Society

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