69666 Repair oval window fistula

Name of the Procedure:

Repair Oval Window Fistula (OWF)

• Also known as: Oval Window Fistula Repair Surgery

Summary

Repairing an oval window fistula involves surgical intervention to restore the integrity of the oval window membrane in the inner ear, which can become torn or damaged, leading to hearing loss, vertigo, and other symptoms. The procedure seals the fistula to prevent the leakage of inner ear fluids.

Purpose

• Medical Condition: It addresses perilymph fistula, an abnormal connection allowing fluid to leak from the inner ear to the middle ear.
• Goals: The primary goals are to halt the leakage of inner ear fluid, improve hearing, and alleviate vertigo and other associated symptoms.

Indications

• Symptoms: Dizziness, vertigo, hearing loss, tinnitus, and feelings of ear fullness or pressure.
• Patient Criteria: Individuals diagnosed with an oval window fistula via clinical examination and imaging studies, typically those who have not responded to conservative treatments.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours before surgery and adjust or pause certain medications as directed by their healthcare provider.
• Diagnostic Tests: Audiometric evaluations, vestibular testing, and imaging studies such as CT or MRI scans.

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made in the ear canal to access the middle ear.
3. The surgeon identifies the fistula and delicately seals it using a graft material, commonly a tiny piece of tissue from the patient.
4. The site is secured, and the incision is closed.

• Tools: Microsurgical instruments, graft materials.
• Anesthesia: General anesthesia is used to keep the patient unconscious and pain-free during the procedure.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

• Performed in a hospital or surgical center's operating room.

Personnel

• Surgeons specialized in otologic or neurotologic surgery.
• Supporting nurses and surgical assistants.
• Anesthesiologists for the administration and monitoring of anesthesia.

Risks and Complications

• Common Risks: Infection, bleeding, temporary dizziness or unsteadiness.
• Rare Complications: Persistent vertigo, hearing loss, damage to the facial nerve, cerebrospinal fluid leak.

Benefits

• Expected Benefits: Improved hearing, reduction or elimination of vertigo, and overall enhancement in quality of life.
• Realization of Benefits: Often noticed within a few weeks post-surgery.

Recovery

• Post-procedure: The patient may need to stay in the hospital for observation, typically for 1 to 2 days.
• Instructions: Avoiding heavy lifting, straining, and activities that cause rapid head movements.
• Recovery Time: Full recovery can take several weeks, with most normal activities resuming within a few weeks.
• Follow-up: Regular follow-up appointments to monitor healing and hearing function.

Alternatives

• Observation: Waiting to see if symptoms resolve on their own, often recommended for mild cases.
• Non-surgical: Positional maneuvers, bed rest, and medications.
• Pros and Cons: Surgery offers a definitive solution but carries surgical risks, whereas non-surgical options have fewer immediate risks but may not be as effective.

Patient Experience

• During the Procedure: The patient is under general anesthesia and will not feel anything.
• Post-procedure: Pain and discomfort around the ear, which can be managed with prescribed pain relievers.
• Comfort Measures: Use of pain medication, rest, and guidance on gradual return to normal activities.