A perilymph fistula, also called a PLF, is a tear in one of the membranes separating the middle & the inner ear. While the middle ear is usually filled with air, the inner ear contains a fluid called perilymph. The middle ear & the inner ear are separated by thin membranes called oval & round windows. When these membranes rupture or tear, the perilymph fluid inside the inner ear can flow into the middle ear, where it causes problems with the body’s balance, hearing issues, & pressure inside the ear.
Perilymph Fistula can cause patients to feel dizzy, nauseous, disoriented, & unsteady.
Perilymph Fistula symptoms:
Perilymph Fistula symptoms often include a range of signs such as:
- A feeling of pressure & fullness in the ear,
- Sudden hearing loss
- Persistent, fluctuating hearing loss that comes & goes
- Dizziness & vertigo
- Mild, persistent nausea
- Memory loss
- Motion sickness
- A feeling of swaying to one side, feeling unbalanced
- Ringing sound in the ears also called tinnitus
Your perilymph fistula symptoms may get worse when you experience altitude changes like in a flight or while paragliding, lift heavy objects, sneeze forcefully, cough forcefully, & laugh excessively.
It’s important to remember that perilymph fistula symptoms differ for every individual. Some people experience the above-mentioned symptoms quite severely, while some others report feeling just a wee bit ‘off. Some other patients of perilymph fistula don’t have any symptoms at all.
Perilymph Fistula usually affects only one ear at a time. Bilateral perilymph fistula is quite uncommon & rare, however, in some cases, severe head trauma or head injury can cause bilateral perilymph fistula.
Perilymph Fistula causes:
Perilymph Fistula can occur when you experience any kind of head injury or barotrauma (quick, rapid changes in the pressure). These changes can happen during travel, scuba diving, childbirth, & heavyweight lifting.
Other potential perilymph fistula causes include:
- Experiencing any kind of whiplash
- An eardrum puncture
- Exposure to very loud sounds very close to the ear, like gunfire or loud sirens
- Any kind of serious, frequent ear infections
- Blowing your nose very hard
In some cases, perilymph fistula can even be present since birth. In some other cases, people complain of developing perilymph fistula symptoms suddenly & unexpectedly, without any of the above-mentioned causes & risk factors.
However, most of these cases of perilymph fistula are caused by an underlying injury or infection that might not have caused any immediate symptoms or issues.
How is Perilymph Fistula diagnosed?
Diagnosing Perilymph Fistula can prove to be somewhat of a difficult task, as the symptoms of a perilymph fistula can easily mimic those of other vestibular conditions as well. Things like head injuries & concussions can have the same symptoms as Perilymph Fistula & cause similar kinds of signs. Perilymph Fistula symptoms like hearing loss & tinnitus also resemble those of Meniere’s Disease, making a perilymph fistula diagnosis even harder. It’s of vital importance to get an accurate diagnosis of your exact condition from a trained doctor, as treatment strategies for Perilymph Fistula & other various vestibular conditions differ a lot.
Your doctor might order a lot of different tests on you to get an accurate diagnosis. These include:
- Hearing tests that gauge your hearing functions
- Balance tests that check the functioning of the vestibular system
- CT scans
- MRI scans
- An electrocochleography test that determines the functioning of your inner ear in response to sounds to understand if the pressure inside the ear is off the chart
- A perilymph fistula test that tracks the movement of your eyes while pressure is applied to your external auditory canal
In most cases, the test results combined with your extensive medical history can help a doctor determine whether or not you’re actually suffering from a perilymph fistula. CT scans & MRI scans, along with careful surgical exploration are usually the determining factors for a diagnosis of perilymph fistula.
Perilymph Fistula treatment:
Perilymph Fistula can be treated in several ways, depending on exactly what symptoms you’re experiencing at the time of the diagnosis. The first line of treatment is often a simple one; bed rest & restriction on activities for a few weeks upto a month. If this shows a certain improvement in your condition, then your doctor might stick to this treatment only.
They might also check back with you in a few follow-up visits to see if the improvement in your condition continues. There is also another line of treatment that is relatively new but has shown tremendous success in perilymph fistula treatment. It’s called the blood patch injection treatment. The treatment works by injecting some of your blood into the middle ear to repair the ruptured window Membrane between the middle ear & the inner ear.
If your perilymph fistula symptoms determine so, your doctor might even use the blood patch injection as the first line of treatment, before any other medicines or remedies.
In a 2016 study reviewed by medical researchers on the efficacy of the blood patch injection treatment method for perilymph fistula, it was found that out of the 12 study subjects enrolled, perilymph fistula symptoms improved for 11. All 12 of them had been given the blood patch injection treatment.
Is there a need for surgery in perilymph fistula treatment?
If your perilymph fistula symptoms don’t seem to be improving after all of the above-mentioned treatment methods have been tried, your doctor might recommend perilymph fistula surgery.
The surgery for perilymph fistula treatment is a relatively simple & quick procedure. It involves lifting the eardrum so that the surgeon can place tissue grafts over the broken membrane between the middle ear and the inner ear.
This surgery takes about 30 to 60 minutes to complete, & often proves to be helpful in relieving the patient’s dizziness. A hearing loss, however, may not even go away with the surgery, as has been seen in some perilymph fistula cases.
Once you get the surgery, you’ll be required to avoid any activities for at least 3 days. After the 3-day period is over, you’ll still have to follow certain guidelines & be careful not to over-exert yourself physically.
Specifically, you’ll need to avoid:
- Lifting any weight over 10 pounds
- Activities that could be a cause for strain, like diving or weight lifting
- Sleeping with your head in an elevated position
It’s important to follow all the guidelines & safety tips given by your doctor during the perilymph fistula surgery recovery period. If you don’t, you risk straining the yet-to-be-repaired fistula, leaving you with persistent & even severe perilymph fistula symptoms.
Diagnosing & treating perilymph fistula can be difficult. But if you’re in the hands of expert specialists & vertigo doctors, perilymph fistula treatment, along with dizziness & vertigo treatment, becomes a breeze.