Two days after stapedotomy, a patient develops severe vertigo, new profound sensorineural hearing loss and a positive fistula sign. What is the most appropriate response?
Severe vestibular symptoms with new cochlear loss after stapes surgery are red flags requiring prompt reassessment and possible revision, not routine postoperative reassurance.
A. Urgent senior otology assessment for suspected perilymph leak or prosthesis complication: Severe vestibular symptoms with new cochlear loss after stapes surgery are red flags requiring prompt reassessment and possible revision, not routine postoperative reassurance.
B. Reassure that all vertigo is expected: Mild transient dizziness may occur, but profound hearing change is not routine.
C. Start vestibular rehabilitation only: Rehabilitation does not address a potentially correctable surgical complication.
D. Perform repeated pneumatic otoscopy: Provoking pressure can worsen symptoms and does not replace specialist assessment.
E. Wait for a six-week audiogram: Delay could reduce the chance of rescuing hearing or controlling a leak.
If dizziness were mild, improving and unaccompanied by hearing change or fistula symptoms, observation with safety-netting could be appropriate.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
Back to the Section 1 bank