What is perilymph fistula?

A perilymph fistula (PLF) is a tear of defect in the membranes that separate the middle ear from the perilymphatic space in the inner ear. The tear can allow fluid to leak into the middle ear. It can also cause changes of pressure in the middle ear, which will impact the inner ear, causing abnormal symptoms.

Causes of perilymph fistula

The most common cause of a perilymph fistula is head trauma, typically involving a blow to the head. Other causes of perilymph fistula include:

  • Perforated eardrum
  • Ear trauma
  • Ear block as you change altitude
  • Rapid increase in intracranial pressure that can occur during childbirth or other intense body activities

Symptoms of perilymph fistula

Symptoms of a perilymph fistula include:

  • Fullness in the ear
  • Sensitive hearing 
  • Dizziness
  • Intolerance to motion 
  • Rarely, patients who have perilymph fistula can develop sudden hearing loss or vertigo

Symptoms often become worse when changing altitude or when pressure in the ear increases when lifting heavy objects, bending or when you cough or sneeze.

Diagnosis of perilymph fistula

It is difficult to definitively diagnose a perilymph fistula. Your doctor may diagnose by evaluating your medical history, symptoms and performing a variety of tests such as:

  • Hearing test 
  • Balance test
  • Fistula test

If you experience sudden hearing loss or dizziness as a result of a traumatic event, your doctor will advise you to severely restrict activity for 7–14 days. If your symptoms don’t improve over this time, your doctor will order a hearing test, balance test or a fistula test. 

Treatment of perilymph fistula

If you are diagnosed with perilymph fistula, your doctor may recommend surgery to patch the tear or hole in the middle ear membrane. The surgery will be performed under general anesthesia. Your doctor will enter the middle ear through the ear canal. He or she will lift the eardrum and place soft tissue grafts around the base of the stirrup and in the round window niche. 

The entire surgery takes approximately 60 minutes to complete. Most patients need a night in the hospital to recover. Once discharged, patients will be advised to restrict physical activity for three days. After three days, you can gradually return to your activities, but you should not lift anything over 10 pounds or participate in sports. Most patients are advised to avoid contact sports, scuba diving, lifting weights and roller coasters for a few months after the procedure.

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