Therapeutic management of barotraumatic perilymphatic fistula: a narrative review

Barotraumatic perilymphatic fistula is a rare and puzzling condition. Its management includes conservative and surgical treatments. The latter involves exploring tympanotomy with fistula sealing and intratympanic injection of autologous blood (“blood patch”). The aim of the present study was to investigate the current therapeutic management of barotraumatic perilymphatic fistula. A comprehensive review of PubMed literature was performed identifying articles, from 2012 on, reporting the therapeutic management of suspected or diagnosed barotraumatic perilymphatic fistula. A total of 81 ears affected by barotraumatic perilymphatic fistula were identified. Exploring tympanotomy was performed in 66 out of 81 ears and a definitive diagnosis was made in 66.7% of cases. Conservative treatment was used in 11 out of 81 (13.6%) ears, it was the definitive treatment in 27.3% of cases and 66.7% of these complained of persistent instability. Sixty-six out of 81 (81.5%) cases underwent exploring tympanotomy with fistula sealing, 100% of these showed auditory improvement and 97.6% a vestibular one. Blood patch was performed in 12 out of 81 (14.8%) ears, only 0.8% reported no improvement and no one complained of clinical worsening after treatment. To these days, exploring tympanotomy with fistula sealing is considered the gold standard for barotraumatic perilymphatic fistula treatment. Although intratympanic injection of autologous blood presents many advantages and shows promising results, more studies are needed to establish it as a new first-line treatment. (Cite this article as: Canzi P, Ottoboni I, Stellato AC, Quaglieri S, Minervini D, Chiapperini C, et al. Therapeutic management of barotraumatic perilymphatic fistula: a narrative review. Otorhinolaryngology 2024;74:38-43. DOI: 10.23736/S2724-6302.23.02516-1)