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 middle ear called round and oval windows may 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. (read more)
The symptoms of a Perilymph Fistula or PLF are:
Fullness of the ear
Fluctuating hearing loss
Vertigo – spells usually lasting for seconds (click here)
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 Valsalvamaneuver 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 tistula, 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 perilymph from leaking. Inspite 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 next three days post surgery. An overnight hospitalization is advisable.After three days rest, for the next 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 given laxatives after surgery to avoid straining.
Author: Dr. Anita Bhandari
Dr.Anita Bhandari is MS(ENT) and a consultant Neurotologist practicing in Jaipur, India. She has done a fellowship in Otology and Neurotology from Singapore. She has set up a state-of-art Vertigo and Ear Clinic in Jaipur (www.vertigoandearclinic.com) which is amongst the most advanced vertigo clinics in India.
Dr. Bhandari is actively involved in development of diagnostic equipment in the field of diagnosis and rehabilitation of vertigo and balance disorders. She has contributed to the development of Computerized Dynamic Visual Acuity , Cranio-Coprpography , Subjective Visual Vertical , Video Nystagmography and
Posturography diagnostic equipment and has two patents in this field . She has also been involved in development of Virtual reality for vestibular rehabilitation . She is Scientific advisor to NeuroEquilibrium, a unique project to set up 500 super-specialized vertigo and dizziness clinics in India , Asia & Africa leveraging cloud technology.
She has authored chapters on ‘Vestibular Physiology’, ‘Dynamic Visual Acuity’, ‘Surgical treatment of vertigo’, ‘Difficult cases in vertigo’ in various Neurotology textbooks. She is an invited speaker in various Vertigo & Neurotology conferences across the world.