KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD
The patient information provided by deJong is insufficient to make a recommendation regarding exploration for a PLF. The differential diagnosis of fluctuating SNHL (presumably stable) in a child is extensive,1,2 and additional data are necessary to eliminate a myriad of alternative diagnoses. From the history, for example, information is needed regarding any unusual exertion, family history of hearing loss, perinatal risk factors, history of drug or toxin exposure, or history of infection. Regarding the physical examination, despite the absence of vestibular symptoms, careful evaluation of vestibular function should be undertaken.3 Laboratory testing should be performed to exclude metabolic, endocrine, and autoimmune disorders. The computed tomographic scan should be reviewed by the responsible physician to ensure the quality of the study and to confirm that the temporal bone structures are indeed normal, not only morphologically but also in dimension.4,5
Gulya AJ. Perilymphatic Fistula: A Logical Approach. Arch Otolaryngol Head Neck Surg. 1998;124(11):1282–1283. doi:10.1001/archotol.124.11.1282
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