Perilymph Fistula

The structures of the inner ear are delicate and cannot tolerate exposure to risks like excessive pressure. Some activities like diving can increase the risk of developing inner ear injuries like perilymph fistulas.

• Perilymph fistula can be symptomatic
• Fortunately, the condition is highly treatable

Perilymph fistula refers to a tearing of the membrane that separates the middle ear and the inner ear. If there is a violation of the inner ear, it allows fluid to leak from the inner ear.

Divers in particular are at risk of this condition. As they dive, the water rushes into their ears, putting pressure on the membrane. The diver then has to pop their ear to create pressure in the middle ear (behind the ear drum) to counteract the water pressure. If the diver cannot pop their ear, then the increased pressure behind the ear drum is put onto the inner ear membrane (round or oval window) and causes an abnormal connection between the inner ear and middle ear.

However, perilymph fistulas also may be caused by the pressure change in an airplane cabin (usually on descent) or by heavy lifting or very strong nose blowing. It is imperative that you know what symptoms to be on the lookout for if you participate in diving, travel frequently by airplane, or do heavy lifting on your job.

The symptoms of perilymph fistula are marked and disruptive to your daily routine. Some of the primary symptoms of which you should be aware include:

• Dizziness usually with pressure change (elevator, coughing, sneezing, etc.)
• Feeling lightheaded
• Tinnitus or ringing in the ears
• Intolerance to motion

You also may feel nauseated or you may vomit because of the tear in the inner ear membrane.

It is important that you seek medical help if you experience any of these symptoms after engaging in activities that put you at risk for perilymph fistula. Your doctor will perform a thorough examination of your ear. He or she may also order a CT scan or MRI to rule out other factors such as superior canal dehiscence or tumors.

Treatment of perilymph fistula is primarily surgical. While bed rest and non-surgical treatment has been advocated for the treatment of this condition, these risk 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.

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.