Perilymph oozer... Discussion

Amit Keshri...
what to do when one face with perilymph oozer intraop in case of stapedotomy small fenestrae, u see a oozer, which stop with coservative management... to put a piston or not ? what is group experience

Amit Keshri.... faced with a similar case i first elevated the head end of patient ,the oozer dint stop,then gave i.v. mannitol, it decreased markedly, then i was able to put piston with fat around the fenestra leak stopped,hearing improved intraop,post op was uneventful,she was kept on acetazolamide, but 1 week later patient complained of fluctuated hearing but no vertigo,post op PTA showed conductive loss (moderate), i wonder what went wrong....piston displacement ? granuloma? or perilymph component of snhl in PTA and no vertigo

Rakesh Srivastava .....When you have got postop.audiometry(days? is it 7th day). if 7th day then wait..Give steroids for 1 week(pred 1mg/kg)

Suri Prabhu.... Amit Keshri - the procedure must be completed
And apparently in such a situation the surgeon ( due to stress/panic) might put in a piston which is a little too short
The usual cause for immediate post-op conductive loss (in all stapedectomies) is the "short" piston
It must difficult to get exact measurement of piston once the gusher starts - so the measurement must be done before the footplate is violated
I have never had the experience of dealing with a "gusher"

Ravi Meher... also it is good option to place a vein graft...

Ravi Meher.... Dr Suri Prabhu, and i am also lucky, not have experienced gusher till date...

Amit Keshri ......‎Rakesh Srivastava sir i got audiometry done on 7th post op day sir,pt will come for follow up next week, Ravi Meher sir i also dint saw any before i encountered one, it was difficult to put a graft as it floated when i kept fascia,only after placing piston it was stopped,as i made small fenestrae, Suri Prabhu sir i was really scared as i was worried about snhl,piston size i put was was adequate but this kind of mistake may happen when one is panic like i accept i was, but reading theory helped me n patient in this rare situation.

Rakesh Srivastava ....One of my professor used to put vein graft in all cases. But I think vein graft is right choice in this circumstances.Amit Keshri.

Suri Prabhu...... ‎Rakesh Srivastava - the surgeon has no choice - when he is faced with a gusher -

and if i may be allowed to comment (only because i have watched actual 'gushers' - and edited videos of 'gushers') -

let me say this -

1. when the gusher starts - the experience is like the man who has gone to the beach on a sunday to enjoy the sea and the warm breeze - and then - SUDDENLY - without warning - he has to deal with a 18 foot TSUNAMI -

2. AT THIS POINT - panic is the usual response - and the surgeon tries everything to stem the flow - AND NOTHING WORKS - the surgeon tries to put in gel foam, vein graft, and fat to stem the flow - BUT NOTHING WORKS -

3. next the operation table is sloped towards the feet - EVEN THAT DOES NOT WORK -

4. after an interval - which might vary between 20 minutes and two hours - the flow reduces - and might magically stop -

5. this is the point where the surgeon might want to complete the procedure in the normal way -

AKA - Patience and Savoir-faire - might be good for both patient and the doctor -