Perilymph Fistula in Emergency Medicine Clinical Presentation

  • Author: Nancy E Conroy, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 13, 2012
 

History

History for perilymph fistula may include the following:

  • Fluctuating sensorineural hearing loss that may be sudden or progressive
  • Vestibular symptoms
    • Vertigo, with or without head position changes
    • Dysequilibrium
    • Motion intolerance
    • Nausea and vomiting
    • Disorganization of memory and concentration
    • Perceptual disorganization in complex surroundings such as crowds or traffic
  • Tinnitus - May be roaring in nature
  • Aural fullness
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Physical

  • Positive test results for vestibular dysfunction or hearing loss, while helpful, are not pathognomonic.
  • Romberg (feet together) or tandem Romberg (heel-to-toe) test findings may be positive.
  • Positional nystagmus and benign paroxysmal positional vertigo often are associated with traumatic perilymph fistula.
  • Sensorineural hearing loss may be confirmed by audiograms.
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Causes

  • Prior stapes surgery
  • Head trauma, including whiplash injuries
  • Barotrauma
  • Acoustic trauma
  • Idiopathic or spontaneous, possibly related to episodes of valsalvae, nose blowing, or physical exertion (The existence of spontaneous perilymph fistula is still an area of controversy among otologists.)
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Nancy E Conroy, MD  Clinical Assistant Instructor, Staff Physician, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn

Nancy E Conroy, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Medical Society of the State of New York, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mert Erogul, MD  Assistant Professor of Emergency Medicine, University Hospital of Brooklyn: Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Mert Erogul, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  2. Ikezono T, Shindo S, Sekiguchi S, Hanprasertpong C, Li L, Pawankar R, et al. Cochlin-Tomoprotein: A Novel Perilymph-Specific Protein and a Potential Marker for the Diagnosis of Perilymphatic Fistula. Audiol Neurootol. Apr 15 2009;14(5):338-344. [Medline].

  3. Ikezono T, Shindo S, Sekine K, Shiiba K, Matsuda H, Kusama K, et al. Cochlin-tomoprotein (CTP) detection test identifies traumatic perilymphatic fistula due to penetrating middle ear injury. Acta Otolaryngol. Sep 2011;131(9):937-44. [Medline].

  4. Bhansali SA. Perilymph fistula. Ear Nose Throat J. Jan 1989;68(1):11, 14-6, 21-8. [Medline].

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  8. Fitzgerald DC, Getson P, Brasseux CO. Perilymphatic fistula: a Washington, DC, experience. Ann Otol Rhinol Laryngol. Oct 1997;106(10 Pt 1):830-7. [Medline].

  9. Friedland DR, Wackym PA. A critical appraisal of spontaneous perilymphatic fistulas of the inner ear. Am J Otol. Mar 1999;20(2):261-76; discussion 276-9. [Medline].

  10. Grimm RJ, Hemenway WG, Lebray PR, Black FO. The perilymph fistula syndrome defined in mild head trauma. Acta Otolaryngol Suppl. 1989;464:1-40. [Medline].

  11. Jones R. Current status of perilymphatic fistula. Arch Otolaryngol Head Neck Surg. Nov 1998;124(11):1281-2. [Medline].

  12. Meyerhoff WL, Marple BF. Perilymphatic fistula. Otolaryngol Clin North Am. Apr 1994;27(2):411-26. [Medline].

  13. Minor LB. Labyrinthine fistulae: pathobiology and management. Curr Opin Otolaryngol Head Neck Surg. Oct 2003;11(5):340-6. [Medline].

  14. Wall C, Rauch SD. Perilymph fistula pathophysiology. Otolaryngol Head Neck Surg. Jan 1995;112(1):145-53. [Medline].

 
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