A perilymph fistula occurs inside the ear when there is a tear in the thin membrane called the oval or round window.This window separates the inner ear from the middle ear. The inner ear is filled with a fluid called perilymph, so when the tear occurs it causes fluid to leak into the middle-ear space. The middle ear normally is filled with air and doesn’t contain any fluid.
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Causes
More rarely, perilymph fistulas can happen during childbirth, can be congenital (have happened before birth), or from other unknown causes.
Symptoms
You may experience some or all of the following symptoms with a perilymph fistula:
Symptoms of perilymph fistula may become worse when you change altitude.
Diagnosis
Diagnosis of a perilymph fistula can be difficult because symptoms overlap with other inner ear disorders such asMeniere’s disease. There also is not a “gold standard” test for diagnosing a perilymph fistula. However, you can sometimes make the diagnosis from anMRIorCT scan.
Since the diagnosis can be so challenging and treatment can often involve surgical intervention, they recommend receiving asecond opinionas well as the following tests to increase the likelihood of an accurate diagnosis:
A thorough history can be very important in helping your healthcare provider determine whether or not perilymph fistula is a possible problem that is causing your symptoms. It is common to have your symptoms get worse when you are sneezing, straining, or coughing, and you should share this with your healthcare provider. Another common symptom is theTullio phenomenon, which causes you to experience vertigo when exposed to loud sounds.
Of the tests listed above, there is some research that suggests that the best way to make a diagnosis of perilymph fistula is a thorough medical history and a positive fistula or Fraser test.
Treatment
The two main treatment options are surgical repair or strict bed rest to allow your body to repair the fistula on its own. Many factors can affect the decision of whether to use a non-surgical or surgical approach. As long as symptoms are improving your healthcare provider may continue bed rest or strict activity restriction for up to six months before considering surgical repair of a perilymph fistula.
Certain medications may help treat symptoms but will not have any effect on the fistula itself. For example, medications like ondansetron and promethazine may be used to control nausea. Diazepam is another medication that is sometimes used.
Surgical repair of a perilymph fistula involves a tissue graft to repair the tear in the round window. This repair can be effective—one case series found that 82% of people had “marked improvement” in symptoms a week after surgery—although factors such as the size of the fistula, amount of leakage, and the time between onset of symptoms and surgery will affect the specific outcomes.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Vestibular Disorders Association.Perilymph fistula.Matsuda H, Hornibrook J, Ikezono T.Assessing the efficacy of perilymphatic fistula repair surgery in alleviating vestibular symptoms and associated auditory impairments.Front Neurol. 2023 Oct 12;14:1269298. doi:10.3389/fneur.2023.1269298Additional ReadingMeldrum JA, Prinsley PR.Perilymph fistula: The patients’ experience.The Journal of Laryngology & Otology. 2016;130, 526–531. doi:10.1017/S002221511600030X
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Vestibular Disorders Association.Perilymph fistula.Matsuda H, Hornibrook J, Ikezono T.Assessing the efficacy of perilymphatic fistula repair surgery in alleviating vestibular symptoms and associated auditory impairments.Front Neurol. 2023 Oct 12;14:1269298. doi:10.3389/fneur.2023.1269298Additional ReadingMeldrum JA, Prinsley PR.Perilymph fistula: The patients’ experience.The Journal of Laryngology & Otology. 2016;130, 526–531. doi:10.1017/S002221511600030X
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Vestibular Disorders Association.Perilymph fistula.Matsuda H, Hornibrook J, Ikezono T.Assessing the efficacy of perilymphatic fistula repair surgery in alleviating vestibular symptoms and associated auditory impairments.Front Neurol. 2023 Oct 12;14:1269298. doi:10.3389/fneur.2023.1269298
Vestibular Disorders Association.Perilymph fistula.
Matsuda H, Hornibrook J, Ikezono T.Assessing the efficacy of perilymphatic fistula repair surgery in alleviating vestibular symptoms and associated auditory impairments.Front Neurol. 2023 Oct 12;14:1269298. doi:10.3389/fneur.2023.1269298
Meldrum JA, Prinsley PR.Perilymph fistula: The patients’ experience.The Journal of Laryngology & Otology. 2016;130, 526–531. doi:10.1017/S002221511600030X
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