The inner ear (hearing and balance organs) is encased in bone and communicates with the middle ear (the space behind the ear drum) in two locations. These two areas are covered with a thin membrane and are termed the round and oval windows. If for some reason a communication develops between the inner ear fluid and the middle ear space, it is called a perilymphatic fistula. See Anatomy of the Ear for reference.
The leakage of fluids from the inner ear can cause hearing loss (either mild or severe) which may be fluctuating, ringing in the ears, and dizziness. These symptoms are worsened with any pressure change.
Once the diagnosis has been established, the treatment is by performing a surgery and repairing the site of the leak.
Patients with perilymph fistula presents with a sudden or fluctuating hearing loss and/or dizziness. The disturbance in balance may be a sensation of rotation (vertigo), lightheadedness, disequilibrium, motion intolerance, or any combination of the above. The symptoms are especially seen with coughing, straining, loud noise, bending over, or with pressure changes, such as in an elevator.
Perilymph fistulas are most commonly caused by sudden pressure changes such as in SCUBA diving, ascent or descent on a plane, weightlifting among others. Patients who have undergone a stapedectomy operation, are prone to developing perilymph fistulas.
How is a Diagnosis Made?
Generally after a complete history and physical exam, some tests need to be performed to diagnose the cause of facial paralysis. A test of the hearing (audiogram and tympanogram) and a balance test (electronystagmography (ENG)), and other specialized hearing tests (electrocochleography (ECoG)) are performed. A CT scan (special x-ray) of the temporal bone is necessary to ascertain the diagnosis.
Treatment of perilymph fistula once the diagnosis is made is surgical. While bed rest and non-surgical treatment has been advocated for the treatment of this condition, which risks further deterioration of hearing and balance function. Our approach is to first try the blood patch procedure, which can be performed in the office. Most commonly, the blood patch procedure works the first time. Occasionally, it has to be repeated. If the blood patch procedure only works temporarily both times, the surgical procedure can be done. The surgical procedure, which takes about 30 minutes, involves lifting up the ear drum through the ear canal and patching the round and oval windows.
For a video of the surgical procedure, please click below. Please note that this is a surgical video and may not be appropriate for some viewers.
RECENT ADVANCES IN THE TREATMENT OF PERILYMPH FISTULA
In a recently published study performed by Dr. Djalilian at UC Irvine, patients with recent onset perilymph fistulas were treated with an injection of blood in the middle ear (space behind the ear drum). All patients experienced improvement of symptoms. In some patients a repeated injection had to be performed.
The recovery from perilymphatic fistula surgery involves two weeks of no strenuous activity, no lifting over 20 lbs, sleeping with the head of the bed elevated, and no straining. Normal activities may be resumed after that. The chance that the dizziness will improve after surgery is very high, although the likelihood of hearing recovery is low.