Perilymph Fistula (PLF) occurs when there is an abnormal connection between the air-filled middle ear and the fluid-filled inner ear. This condition typically results from a tear in the thin membranes of the middle ear, known as the round and oval windows. These tears can occur due to injury or disease, allowing perilymph, the fluid from the inner ear, to leak into the middle ear.
Symptom Worsening: Changes in atmospheric pressure, such as during airplane travel, elevator rides, or activities like coughing, sneezing, bending, or lifting, can exacerbate symptoms.
To diagnose a perilymph fistula, several tests may be conducted:
Managing Symptoms
Surgical Intervention
If symptoms persist despite conservative measures, surgery may be required:
Note: Following these precautions is crucial to prevent the recurrence of PLF symptoms, even after successful surgery.
A perilymph fistula is repaired by sealing the fluid leak between the inner and middle ear. Initial care may include bed rest, head elevation, avoiding straining, and stopping activities that increase ear pressure. If symptoms persist, a specialist can perform a surgical patch, often using the patient’s own tissue to close the defect. Recovery focuses on protecting the ear from pressure changes while healing progresses.
The most common site of a perilymph fistula is the oval window, followed by the round window, both located between the middle and inner ear. These areas are naturally thin and vulnerable to sudden pressure changes from trauma, heavy lifting, forceful nose blowing, or barotrauma. Defects here can allow inner ear fluid to escape, triggering vertigo, hearing changes, and imbalance.
Testing includes a clinical exam and pressure-based assessments. The fistula test applies gentle pressure to the tragus or uses pneumatic otoscopy to observe dizziness or abnormal eye movements. Audiometry checks for sensorineural hearing changes. Imaging may help rule out other causes. Diagnosis is often based on symptoms combined with pressure sensitivity rather than a single definitive scan.
A labyrinthine fistula is a bony defect, often from chronic ear disease like cholesteatoma, that exposes the inner ear and may cause vertigo when pressure changes occur. A perilymph fistula specifically involves a tear or membrane defect that causes inner ear fluid to leak. All perilymph fistulas involve fluid disruption, but not all labyrinthine fistulas leak fluid.
Yes, it can be serious. Untreated leaks may lead to ongoing vertigo, imbalance, tinnitus, and permanent sensorineural hearing loss. Symptoms often worsen with pressure changes, making daily function difficult. Neuroequillibrium brings specialized clinical experience in vestibular disorders, including perilymph-related dizziness, and supports accurate diagnosis through targeted balance and inner ear function testing.
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