Recurrence of perilymphatic fistula.

Recurrence of the perilymphatic fistula is not rare and may be a tough problem for surgical treatment. This is because a graft is usually applied on the ruptured window(s) from the middle ear and therefore the perilymphatic pressure directly acts on the graft. The recurrence may be caused by a technical failure, use of an unsuitable graft material, poor postoperative bedrest, trauma, increased inner ear pressure, etc. In our clinic, the recurrence occurred in 7 of 48 cases surgically treated. Vertigo accompanied with spontaneous or positional nystagmus was seen in all 7 recurrent cases, while only 2 of them complained of worsening of the existing hearing loss. Re-operation was carried out in two patients. In the first case, closure of the round window by the previous operation was found incomplete, and the perilymph leaked through the gap around the graft. In the second case, closure of the round window was complete, but perilymph leaked from the oval window. In order to prevent the recurrence, the operation should be carefully performed by using strong and adhesive tissue as a graft material, applying a glue between the graft and the inner ear window(s), and keeping strict postoperative bedrest.