Perilymph Fistula

Perilymph Fistula (PLF) is an abnormal connection between the air-filled middle ear and the fluid-filled inner ear. The thin and tiny membranes of the middle ear called round and oval windows can suffer a tear due to injury or disease. The perilymph or fluid from the inner ear leaks into the middle ear through the oval or round windows.

The symptoms of a Perilymph Fistula or PLF are:

• Feeling fullness in the ear
• Fluctuating hearing loss
• Unsteadiness
• Vertigo – spells usually lasting for seconds

Changes in atmospheric pressure occurring in aeroplanes, elevators, going to heights etc. or activities like coughing, sneezing, bending over or lifting weights can worsen the symptoms of PLF.

VNG guided Valsalva test will help in diagnosing a perilymph fistula. VNG or Frenzel glasses provide a magnified view of nystagmus generated due to the increase in the inner ear pressure by doing the Valsalva manoeuvre or Siegelization. Audiometry should be done to detect any hearing loss.

A traumatic event may result in sudden onset of hearing loss or dizziness. When the vestibular evaluation confirms the diagnosis as Perilymph Fistula, the patient is advised to refrain from physical activities for a week or two.

Usually, sufficient resting heals the tear in the middle ear membranes and stops the perilymph from leaking. In spite of precautions, if the symptoms persist surgery may be required. The PLF patients should avoid coughing, bending over, straining, lifting things or any other such activities that aggravate the symptoms of PLF.

The surgery is done under local anaesthesia to repair the Perilymph Fistula. The operation is carried out through the ear canal. During the operation, the eardrum is raised, and tiny soft tissue grafts are placed around the oval window and the round window.

The patients are advised bed rest and restricted activities at home for the next three days post-surgery. Overnight hospitalization is often advised.

After three days of rest, for the duration of a month, the patient can resume normal, but not strenuous activities. The patient should avoid intense sports activities like weight lifting, diving, flying or roller coaster rides. It is seen that patients experience PLF symptoms again if these precautions are not taken, even after successful surgery. Patients are also given laxatives after surgery to avoid straining.