Oval window fistula.

A 56-year-old woman came to the office complaining of disequilibrium and purulent drainage from her right ear. Five years earlier, she had undergone a right canal-wall-down mastoidectomy with a meatoplasty, and she was fitted for a hearing aid within 4 months of surgery. At that time, however, she began to experience disequilibrium, and she soon stopped wearing her hearing aid. She had become completely deaf in her left ear following completion of a canal-wall-down mastoidectomy 30 years earlier.

Otoscopic examination of the left ear revealed a well-healed and dry mastoidectomy cavity. Inspection of the fight ear revealed a mucosalized cavity with mucoid drainage. A dark area could be seen in the footplate that represented a fistula in the oval window (figure). No sign of a perilymph leak was evident. Dizziness while using a hearing aid pointed to Tullio's phenomenon. A residual cholesteatoma was present just anterior to the oval window niche, and squamous epithelium could be seen on the promontory. The eustachian tube orifice was well visualized.

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Because the patient was able to hear only with her right ear, her mastoid and middle ear disease was managed conservatively with periodic local debridements in the office. Because of the profound sensorineural hearing loss in this ear, she is being considered for cochlear implantation. She was not a candidate for the bone-anchored hearing aid.

Arun Gadre, MD

From the Department of Otolaryngology--Head and Neck Surgery, University of Texas Health Science Center at Houston.