The Journal of International
Advanced Otology
Case Report

Barotrauma-Induced Perilymph Fistula: Video Head Impulse Test and High-Resolution Temporal Bones Computed Tomography Role in Evaluation and FollowUp


Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel


Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel


Department of Otoneurology, Lin Medical Center, Haifa, Israel


University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa, Israel

J Int Adv Otol 2023; 19: 350-354
DOI: 10.5152/iao.2023.22771
Read: 797 Downloads: 328 Published: 01 August 2023

We report a case of a woman presenting with unilateral right profound hearing loss accompanied by vertigo secondary to barotrauma-induced perilymph fistula during recreational skydiving. Video head impulse test demonstrated a reduced gain in both the right horizontal and right anterior semicircular canals accompanied by frequently gathered overt corrective saccades. High-resolution computed tomography revealed an enlarged vestibular aqueduct on the affected side, a predisposing factor for the development of perilymph fistula. An exploratory tympanotomy was performed during which a perilymph leak was visualized at the round window niche. Temporal fascia patches enforced by absorbable gelatin sponges were applied to both round and oval windows. During post-surgery follow-up, the patient remained free of vestibular symptoms. An audiogram displayed mild improvement in the right ear speech reception threshold, although her hearing remained non-serviceable. The video head impulse test showed a favorable dynamic with a stepwise return to normal gain values in all semicircular canals and the disappearance of overt corrective saccades. This is the first case in which video head impulse test was employed as a valuable diagnostic tool for the evaluation and post-surgery follow-up of vestibular function in a barotrauma-induced perilymph fistula. The demonstration of an enlarged vestibular aqueduct on high-resolution computed tomography and the risk of perilymph fistula recurrence are discussed.

Cite this article as: Gutkovich YE, Shlizerman L, Paker M, Mazzawi S, Siag K, Shupak A. Barotrauma-induced perilymph fistula: the role of the video head impulse test and high-resolution temporal bones computed tomography in the evaluation and follow-up. J Int Adv Otol. 2023;19(4):350-354.

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