Summary about Disease
A perilymph fistula (PLF) is an abnormal tear or defect in one or both of the small, thin membranes (the oval window and round window) separating the middle ear from the fluid-filled inner ear. This defect allows perilymph fluid (the fluid of the inner ear) to leak into the middle ear. This leakage can lead to balance problems and hearing loss.
Symptoms
Vertigo (spinning sensation)
Dizziness
Nausea and vomiting
Hearing loss (sudden or progressive)
Tinnitus (ringing in the ears)
Ear fullness or pressure
Sensitivity to loud noises (hyperacusis)
Unsteadiness or imbalance Symptoms can be triggered or worsened by:
Changes in altitude
Straining
Sneezing
Coughing
Loud noises
Causes
Head trauma (e.g., skull fracture, concussion)
Barotrauma (sudden changes in pressure, such as during scuba diving or air travel)
Straining or heavy lifting
Chronic ear infections or middle ear surgery
Congenital (present at birth) defects of the inner ear
Loud noise exposure
Medicine Used
There are no medications to heal the fistula itself. Treatment typically involves addressing the symptoms and allowing the body to heal, or surgical intervention. Medications used may include:
Anti-nausea medications: For nausea and vomiting
Anti-vertigo medications: To reduce dizziness and vertigo
Steroids: In some cases, steroids may be used to reduce inflammation.
Is Communicable
No. Perilymph fistula is not a contagious disease. It cannot be transmitted from person to person.
Precautions
Avoid activities that increase inner ear pressure: This includes heavy lifting, straining, forceful nose blowing, and activities involving pressure changes (scuba diving, air travel).
Rest: Get adequate rest to allow the body to heal.
Elevate head: Sleeping with your head elevated can help reduce pressure in the ear.
Follow medical advice: Adhere to your doctor's recommendations for treatment and activity restrictions.
Manage underlying conditions: Treat any underlying ear infections promptly.
How long does an outbreak last?
There is no “outbreak” of a perilymph fistula as it is not infectious. Symptom duration varies significantly. Some fistulas may heal spontaneously within a few weeks with conservative management. Others may require surgical repair, and the recovery period after surgery can also vary, lasting from weeks to months. Symptoms may be intermittent, with periods of improvement followed by exacerbations.
How is it diagnosed?
Diagnosis can be challenging. There is no single definitive test. Diagnosis typically involves:
Medical history and physical examination: The doctor will ask about symptoms and medical history.
Hearing tests (audiometry): To assess hearing loss.
Balance tests (vestibular testing): To evaluate balance function.
Tympanometry: To assess middle ear function.
Fistula test: Applying pressure to the ear canal and observing for eye movements (nystagmus) or dizziness, though this test is not always reliable.
CT scan or MRI: To rule out other conditions and sometimes to visualize inner ear abnormalities, although these are not always conclusive for PLF.
Exploratory surgery: In some cases, surgery may be necessary to directly visualize the middle and inner ear and confirm the presence of a fistula.
Timeline of Symptoms
The onset of symptoms can be:
Sudden: Often after trauma or pressure changes.
Gradual: Develops over time, possibly with fluctuating intensity.
Intermittent: Symptoms come and go. Symptom progression varies. Some individuals experience a gradual worsening, while others have stable symptoms or periods of improvement.
Important Considerations
Differential Diagnosis: Symptoms of PLF can mimic other conditions, such as Meniere's disease, vestibular neuronitis, and benign paroxysmal positional vertigo (BPPV). Accurate diagnosis is essential.
Conservative Management: Initial treatment often involves conservative measures such as bed rest, head elevation, and avoiding activities that exacerbate symptoms.
Surgical Repair: If conservative measures fail, surgery may be considered to repair the fistula.
Long-Term Outlook: The long-term prognosis varies. Some individuals recover fully, while others may experience persistent symptoms despite treatment.
Prompt medical attention is important: Seek evaluation by an otolaryngologist (ENT doctor) or neurotologist if you suspect you have a perilymph fistula.