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Perilymph Fistula

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About the Disease

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.

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Symptoms

  1.  Fullness in the Ear: A sensation of fullness or pressure in the affected ear.
  2.  Fluctuating Hearing Loss: Hearing may vary, often worsening with changes in pressure.
  3.  Unsteadiness: Feeling off-balance or unsteady.
  4.  Vertigo: Spells of dizziness that usually last for seconds.

 Symptom Worsening: Changes in atmospheric pressure, such as during airplane travel, elevator rides, or activities like coughing, sneezing, bending, or lifting, can exacerbate symptoms.

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Diagnosis

To diagnose a perilymph fistula, several tests may be conducted:

  •  VNG-Guided Valsalva Test: This test helps identify perilymph fistula by observing nystagmus (involuntary eye movement) when increasing inner ear pressure through the Valsalva maneuver.
  •  Audiometry: Used to detect any hearing loss associated with PLF.
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Treatment

Managing Symptoms

  •  Rest: In cases of PLF resulting from a traumatic event, rest and avoidance of physical activities for one to two weeks can help heal the tear in the middle ear membranes and stop the perilymph leakage.
  • Precautions: Patients should avoid activities that increase inner ear pressure, such as coughing, bending over, straining, and lifting heavy objects.

Surgical Intervention
If symptoms persist despite conservative measures, surgery may be required:

  •  Surgery: Performed under local anesthesia through the ear canal. The eardrum is raised, and tiny soft tissue grafts are placed around the oval and round windows to repair the fistula.
  •  Post-Surgery Care: Patients are advised to have bed rest and restricted activities for three days post-surgery, with overnight hospitalization often recommended. After three days, normal activities can be resumed, but strenuous activities should be avoided for a month. Patients should avoid intense sports, weight lifting, diving, flying, and roller coaster rides to prevent recurrence of symptoms.
  •  Laxatives: Given post-surgery to avoid straining during bowel movements.

Note: Following these precautions is crucial to prevent the recurrence of PLF symptoms, even after successful surgery.

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Ear pressure or dizziness after strain? It might be Perilymph Fistula—schedule your appointment today.