Perilymphatic Fistula

The inner ear (hearing and balance organs) is encased in bone and communicates with the middle ear (the space behind the ear drum) in two locations. These two areas are covered with a thin membrane and are termed the round and oval windows.

If for some reason a communication develops between the inner ear fluid and the middle ear space, it is called a perilymphatic fistula.

Symptoms

Symptoms of a perilymphatic fistula include:

• Sudden or fluctuating hearing loss
• Dizziness, which can be a sensation of rotation, lightheadedness or motion intolerance

When bending, straining or coughing, the symptoms worsen.

Causes

Perilymphatic fistulas are most commonly caused by sudden pressure changes such as in SCUBA diving, ascent or descent on a plane and weightlifting.

Patients who have undergone a stapedectomy operation are also prone to developing perilymphatic fistulas.

Diagnosis and treatment

To diagnose a perilymphatic fistula, several tests will be performed:

• Hearing (audiogram and tympanogram)
• Balance test (electronystagmography (ENG)
• Other specialized hearing tests (electrocochleography)

A CT scan will also be given. This can give a view of the temporal bone and confirm the diagnosis.

The treatment of perilymphatic fistula is an injection or surgery.

While bed rest and nonsurgical treatment have been recommended as treatment of this condition, there is a risk of further deterioration of hearing and balance function.

Blood patch

A procedure known as a blood patch is the first line of treatment. This can be can be performed in the office, and you will go home the same day. The blood patch procedure usually works the first time. Occasionally, it has to be repeated.

Surgery

If the blood patch procedure only works temporarily both times, surgery is the next line of treatment. The procedure, which takes about 30 minutes, involves lifting up the ear drum through the ear canal and patching the round and oval windows.

Recovery

The recovery from perilymphatic fistula surgery involves two weeks of:

• No strenuous activity
• No lifting over 20 pounds
• No straining
• Sleeping with the head of the bed elevated

Normal activities may be resumed after that. The chance that the dizziness will improve after surgery is very high, although the likelihood of hearing recovery is low.