On otological examination all of the following will have positive fistula test except:
**Core Concept**
A fistula test, also known as the fistula reaction test, is a clinical assessment used to diagnose a perilymphatic fistula, a condition characterized by an abnormal communication between the perilymphatic and middle ear compartments. This leads to symptoms such as vertigo, hearing loss, and tinnitus. The test involves observing the patient's vestibular response during changes in middle ear pressure.
**Why the Correct Answer is Right**
A dead ear, by definition, refers to a non-functioning auditory system, which would not respond to changes in middle ear pressure. Therefore, a fistula test would be negative in a dead ear. In contrast, a labyrinthine fistula, hypermobile stapes footplate, and following fenestration surgery would all result in a positive fistula test due to the abnormal communication between the perilymphatic and middle ear compartments. The patient would exhibit nystagmus or vertigo in response to changes in middle ear pressure.
**Why Each Wrong Option is Incorrect**
**Option B:** A labyrinthine fistula is a type of perilymphatic fistula that would result in a positive fistula test.
**Option C:** A hypermobile stapes footplate would also lead to a positive fistula test due to the abnormal movement of the stapes bone.
**Option D:** Following fenestration surgery, a patient may experience a perilymphatic fistula, leading to a positive fistula test.
**Clinical Pearl / High-Yield Fact**
It is essential to note that the fistula test is not always reliable and can be affected by various factors, such as the patient's symptoms and the presence of other middle ear pathologies.
**Correct Answer:**
✓ Correct Answer: A. Dead ear