This page was last updated: April 24, 2014
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.
Otolaryngology Houston
Bechara Y. Ghorayeb, MD
1140 Business Center Drive, Suite 560 
Houston, TX 77043.
Phone: (713) 464 2614
www.ghorayeb.com