eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Perilymph Fistula: Follow-up

Author: Nancy E Conroy, MD, Clinical Assistant Instructor, Staff Physician, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn
Coauthor(s): Mert Erogul, MD, Assistant Professor of Emergency Medicine, University Hospital of Brooklyn: Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Jun 30, 2009

Follow-up

Further Inpatient Care

  • Bedrest with the head of the bed elevated to 30°
  • Avoidance of lifting or pressure-increasing activities (ie, Valsalva maneuver)
  • Surgical intervention is the principle approach to treatment when perilymph fistula is diagnosed. The site of perilymph leak is covered with some form of autologous tissue.

Further Outpatient Care

  • Strict bedrest for 5-7 days or until reevaluation
  • Elevation of the patient's head above the heart level
  • Avoidance of straining
  • Avoidance of nose blowing or Valsalva maneuver
  • No lifting (>10 lb)
  • Stool softeners

Complications

  • Both the patient and the physician should be prepared for no response to treatment, especially with regard to hearing improvement. Recurrence of postoperative signs and symptoms may occur in 21-47% of patients.
  • Perilymph fistula may be associated with recurrent meningitis in children.

Prognosis

  • Because of the difficulty in making the diagnosis of perilymph fistula, the natural history of this disorder is unknown.
  • Significant improvement in symptoms that are presumed to be from perilymph fistula may occur with conservative treatment.
  • Surgery is more successful in relieving vertiginous symptoms than in improving hearing.

Miscellaneous

Special Concerns

  • The condition may be a cause of recurrent meningitis in children.
  • In head trauma cases, hearing loss with vertigo suggests a perilymph fistula syndrome until proven otherwise.
 


More on Perilymph Fistula

Overview: Perilymph Fistula
Differential Diagnoses & Workup: Perilymph Fistula
Treatment & Medication: Perilymph Fistula
Follow-up: Perilymph Fistula
References
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References

  1. 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].

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

  3. Bruzzone MG, Grisoli M, De Simone T, Regna-Gladin C. Neuroradiological features of vertigo. Neurol Sci. Mar 2004;25 Suppl 1:S20-3. [Medline].

  4. deJong AL. Congenital perilymphatic fistula. Arch Otolaryngol Head Neck Surg. Nov 1998;124(11):1279-81. [Medline].

  5. Fitzgerald DC. Head trauma: hearing loss and dizziness. J Trauma. Mar 1996;40(3):488-96. [Medline].

  6. 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].

  7. 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].

  8. 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].

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

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

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

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

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Further Reading

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Keywords

perilymph fistula, PLF, perilymph leak, inner ear, perilymph fistula treatment, perilymph fistula causes, perilymph fistula symptoms, perilymphatic fistula, labyrinthine fistula, acute perilymph fistula syndrome, chronic perilymph fistula syndrome, hearing loss, sensorineural hearing loss, vertigo, tinnitus, disequilibrium, aural fullness, benign positional vertigo

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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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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