Perilymphatic Fistula

Overview

What is a perilymphatic fistula?

A perilymphatic fistula (PLF) refers to a hole or tear in one of the membranes that separate your middle ear and inner ear. Your middle ear is filled with air, while your inner ear is filled with fluid (perilymph). These two areas inside of your ear are separated by membranes. If the membranes rupture, then perilymphatic fluid can flow from your inner ear into your middle ear. The resulting pressure changes can cause balance and hearing problems.

Who do perilymphatic fistulas affect?

Perilymphatic fistulas can affect people of all ages. In some cases, PLFs may be present at birth.

Symptoms and Causes

What are the symptoms of a perilymphatic fistula?

Perilymphatic fistula symptoms may include:

Most of the time, PLFs only affect one ear at a time. In rare cases, they can affect both ears at once.

A person with a perilymphatic fistula may notice that their symptoms worsen when the laugh, sneeze or cough. Or, they may experience an increase in symptoms when lifting something heavy or changing altitudes.

What causes perilymphatic fistulas?

Perilymphatic fistulas can be caused by a few different factors, including:

  • Head trauma.
  • Ear trauma.
  • Barotrauma (rapid changes in pressure due to flying, scuba diving, heavy lifting and childbirth).
  • A punctured eardrum.
  • Exposure to loud noises that are close to your ear, such as gunfire.
  • Frequent ear infections.
  • Blowing your nose extremely hard.

Sometimes, it can seem like a perilymphatic fistula develops with no apparent cause. But it’s usually due to an old injury that didn’t cause immediate symptoms.

Diagnosis and Tests

How are perilymphatic fistulas diagnosed?

Perilymphatic fistula symptoms are similar to those of other inner ear conditions, such as Meniere’s disease, vestibular neuritis and labyrinthitis. So, it’s important for your healthcare provider to rule out these other issues. They may recommend a number of tests, including:

  • Hearing tests.
  • Balance tests.
  • Electrocochleography, a test that measures the fluid pressure inside of your inner ear.
  • A perilymphatic fistula test, which tracks your eye movements while pressure is applied to your ear canal.

Your healthcare provider may also use imaging tests to confirm your diagnosis. Perilymphatic fistula radiology tests may include:

  • A CT scan, which produces a 3D X-ray image of the structures inside of your body.
  • MRI, which captures images inside of your body using powerful magnets and radio waves.

In some cases, MRI and CT scans may be combined when diagnosing a perilymphatic fistula.

Management and Treatment

How are perilymphatic fistulas treated?

There are a few different treatment options and approaches, depending on the severity of your condition:

Bed rest

Restricted activity is often the first line of treatment for perilymphatic fistulas. Your healthcare provider may recommend bed rest for one to two weeks. If improvement is noted, then further rest will be recommended until the issue is resolved.

Blood patch injections

During this procedure, your healthcare provider injects your own blood into your middle ear. This helps regenerate the damaged membrane. Blood patch injections are somewhat new, and experts are still researching the treatment. So far, the results are encouraging.

Surgery

If conservative treatments don’t work, then your healthcare provider may recommend surgery. During this procedure, your eardrum is gently lifted and tissue grafts are placed over the damaged membranes between your middle and inner ear. Surgery isn’t right for everyone, so be sure to talk to your healthcare provider about the risks and limitations of this treatment.

How long does it take to recover from perilymphatic fistula surgery?

While most people are comfortable within a few days after surgery, full recovery can take several weeks. During this time, it’s important that you follow all post-operative guidelines provided by your surgeon. In general, you’ll need to sleep with your head elevated and avoid activities that could cause ear strain, such as diving and heavy lifting.

Prevention

Can I prevent perilymphatic fistulas?

While you won’t be able to prevent PLFs altogether, you can take steps to reduce your risk. For example:

  • Protect your ears when you know you’ll be exposed to loud noise.
  • Wear filtered earplugs when traveling by plane. This may help equalize pressure in your ears.
  • If you’re prone to frequent ear infections, ask your healthcare provider about preventative measures.

Outlook / Prognosis

What can I expect if I have a perilymphatic fistula?

If you have symptoms such as balance problems or dizziness, you may need to make modifications to your daily routine. For example, if walking around triggers your symptoms, then have someone else run errands for you. Additionally, avoid situations in which you might lose your balance and fall.

Can perilymphatic fistulas be cured?

Yes. Some PLFs can heal on their own with adequate rest. However, in some cases, blood patch injections or surgery may be necessary.

Living With

When should I see my healthcare provider?

Schedule a visit with your healthcare provider any time you develop changes in your hearing or other sudden symptoms. If you have frequent or severe ear infections, ask your healthcare provider how to reduce your risk for PLF.

A note from Cleveland Clinic

Perilymphatic fistulas can cause a range of troubling symptoms that interfere with your quality of life. If you’re diagnosed with a PLF, your healthcare provider may recommend lots of bed rest, which could help the fistula heal on its own. If bed rest isn’t enough, you may need surgery. It’s important to closely follow the guidelines given by your healthcare provider so you can recover as quickly as possible.

Last reviewed by a Cleveland Clinic medical professional on 02/04/2022.

References

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  • Foster PK. Autologous intratympanic blood patch for presumed perilymphatic fistulas. (https://pubmed.ncbi.nlm.nih.gov/27894374/) J Laryngol Otol. 2016 Dec;130(12):1158-1161. Accessed 2/4/2022.
  • Furhad S, Bokhari AA. Perilymphatic Fistula. (https://www.ncbi.nlm.nih.gov/books/NBK563221/) [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 2/4/2022.
  • Qian Y, Zhong S, Hu G, Kang H, Wang L, Lei Y. Sudden Sensorineural Hearing Loss in Children: A Report of 75 Cases. (https://pubmed.ncbi.nlm.nih.gov/30063499/) Otol Neurotol. 2018 Sep;39(8):1018-1024. Accessed 2/4/2022.
  • Sarna B, Abouzari M, Merna C, Jamshidi S, Saber T, Djalilian HR. Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment. (https://pubmed.ncbi.nlm.nih.gov/33041986/) Front Neurol. 2020 Sep 15;11:1046. Accessed 2/4/2022.

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