Perilenf Fistülü
Özet
Perilenf fistülü (PLF), iç kulaktaki perilenf sıvısının orta kulak veya çevre dokulara anormal geçişiyle ortaya çıkan, nadir fakat klinik olarak önemli bir patolojidir. En sık oval veya yuvarlak pencere membranlarının bütünlüğünün bozulmasıyla meydana gelir. PLF; ani ya da dalgalı işitme kaybı, vertigo, tinnitus ve dengesizlik gibi semptomlarla seyreder. Tanı süreci karmaşıktır; çünkü semptomlar Menière hastalığı ve vestibüler migren gibi diğer hastalıklarla örtüşebilir. Tanı için temporal kemik BT, CISS/FIESTA sekanslı MR, Cochlin-tomoprotein (CTP) gibi biyobelirteçler ve klinik skorlama sistemleri kullanılır. Cerrahi gözlem halen altın standart kabul edilse de, tanıda subjektiflik barındırır. CTP gibi özgül biyobelirteçler ve sanal endoskopi destekli 3D BT analizleri tanıda umut vaat etmektedir. Tedavi yaklaşımı konservatif izlemden intratimpanik kan yamasına ve cerrahi pencere greftlemesine kadar geniştir. PLF’ye yönelik randomize çalışmaların eksikliği dikkat çekerken, multidisipliner yaklaşımlar ve tanı-tedavi algoritmalarının standardizasyonu gereklidir.
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