Complications Of Plfs

Curiously, PLF-related complications are rarely, if ever, discussed in the literature. In addition to the comorbid conditions discussed above, there are three significant complications of PLFs: Hearing loss, vestibular function loss, and meningitis.

Hearing loss is a complication of a PLF and should never be regarded as either a primary consequence or inevitable result of PLF. Hearing loss complicating PLFs is a true otologic emergency. Sensorineural hearing loss indicates hair cell damage and/or death, whereas a conductive or mixed loss (often seen in cases of post-traumatic PLF) indicates a superimposed middle ear component. Probability of improvement in SNHL after PLF closure is 50/50 at best,62 and the likelihood of improvement diminishes rapidly with time.

Once SNHL occurs, it must be treated aggressively. In our experience, the best chance of improving or regaining SNHL thresholds is to begin treatment within 48 to 72 h of the loss. In our practice, sudden SNHL is treated with an ABCS approach consisting of activity restriction, bed rest, carbogen, and surgery.76

Carbogen, a mixture of 95% oxygen and 5% carbon dioxide, has proved an effective treatment in many cases of sudden, emergent SNHL related to PLFs.87-89 The patient is admitted to the hospital, placed on strict bed rest with head elevated, and given carbogen inhalations for 15 min of every hour, around the clock. Treatment is continued for a minimum of 48 h. Serial audiograms are performed and treatment may be continued for an additional 1 to 2 days if hearing is recovering. In our experience, carbogen treatment has often restored sudden SNHL and obviated the need for emergent tympanotomy and PLF repair.

Loss of vestibular function is relatively uncommon in PLFs. The likelihood of vestibular damage is higher in persons with pathologic PLFs or removal of a fractured or unstable stapes. Once vestibular function is lost, it is usually not regained.

Meningitis is an infrequent but potentially life-threatening complication of PLFs.41, 90-93 The abnormal opening between the sterile inner ear and an infected middle ear potentially allows bacteria and viruses to enter the inner ear space. Since peri-lymph is continuous with the CSF, invading organisms can infect the CSF, meninges, and brain, causing meningitis and cerebritis. Because meningitis and cerebritis are life-threatening,94 PLFs from any cause should be closed, through either conservative or surgical means, without delay. Patients with active PLFs should also be instructed to seek medical treatment immediately if they develop symptoms or signs of an upper respiratory or middle ear infection.

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