Perilymph Fistula

A Perilymph fistula (PLF) is an abnormal opening or tear in one or both small, thin membranes separating the middle ear from the inner ear, leading to leakage of inner ear fluid (perilymph) into the middle ear space.

Perilymph fistula can cause both balance and hearing symptoms.  

• Hearing Loss: Can range from mild to severe and may fluctuate. 
• Vertigo or Dizziness: A feeling of spinning or movement or off balance often triggered by change in pressure, such as during air travel or change in altitude. 
• Tinnitus: Ringing, buzzing, or roaring sound in the affected ear. 
• Ear fulness or Pressure: Sensation of fullness in the ear, similar to that experienced during changes in altitude. 
• Sensitivity to sounds

Several factors can lead to the development of a Perilymph fistula.  

• Trauma: Head injury, skull fracture, sudden changes in pressure (such as during scuba diving or rapid changes in altitude), surgery or other treatment. 
• Barotrauma: Pressure changes, particularly if sudden and extreme, can cause a tear in the membranes. 
• Congenital Factors: Some individuals may have structural weaknesses in the membranes that predispose them to developing PLF. 
• Idiopathic: arises spontaneously without a known cause.

Diagnosing a perilymph fistula typically involves a combination of medical history assessment, physical examination, and specific tests.  

• Medical History: The health care specialist will inquire about your symptoms, including any incidents of trauma or exposure to pressure changes. Details about the onset and progression of symptoms are crucial for diagnosis. 
• Physical Examination: The health care specialist may examine your ears and conduct tests to evaluate your hearing and balance function. They may also check for signs of any underlying conditions that could contribute to your symptoms 
• Hearing Tests: Audiometry is commonly performed to assess your hearing ability. This test helps determine the type and extent of hearing loss you may be experiencing. 
• Vestibular Tests: These tests evaluate your balance function and may include electronystagmography (ENG) or videonystagmography (VNG). These tests help assess any abnormalities in your inner ear that could be contributing to your symptoms. 
• Imaging Studies: Imaging tests such as CT scans or MRI scans may be ordered to visualize the structures of the inner ear and detect any abnormalities, such as a tear or defect in the membranes separating the middle ear from the inner ear and also to rule out other possible causes of the symptoms. 

• Conservative Management: Initially, rest and avoid activities that worsen symptoms, such as straining, heavy lifting, or exposure to sudden pressure changes. 
• Medications: Symptomatic relief with medications for dizziness (anti-vertigo medications) or nausea. 
• Surgical Repair: In cases where conservative measures fail, or symptoms are severe, surgical repair of the fistula may be necessary. This typically involves patching the tear or reinforcing the affected area.