A 28-year-old woman undergoes canal wall up mastoidectomy for atticoantral disease. Postoperatively she develops sensorineural hearing loss and severe vertigo. Imaging shows a perilymph fistula at the oval window. Which surgical step most likely caused this complication?

• A Excessive use of suction near the round window membrane
• B Drilling of the posterior canal wall creating a labyrinthine fistula
• C Injury to the chorda tympani nerve causing vasospasm of the internal auditory artery
• D Injury to the stapes footplate during removal of incus or squamous epithelium from oval window niche ✓

Explanation

A perilymph fistula at the oval window during cholesteatoma surgery most commonly results from inadvertent manipulation or traction on cholesteatoma matrix adherent to the stapes footplate, displacing or fracturing the footplate and disrupting the annular ligament. This allows perilymph to leak, causing SNHL and vestibular symptoms. Drilling the posterior canal wall may cause a labyrinthine fistula but typically affects the semicircular canals.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.