Perilymph Fistula in Emergency Medicine Clinical Presentation

Updated: Mar 10, 2016
  • Author: Nancy E Conroy, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Presentation

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

A retrospective study by Haubner et al of 69 patients who suffered unilateral sudden deafness (from sensorineural hearing loss) found that just a minority of these patients had a perilymph fistula. In the study, in which the patients underwent exploratory myringotomy, 18.8% of patients had a visible perilymph fistula, while possible, but doubtful, perilymph fistula was diagnosed in another 21.7%; no signs of fistulae were found in 59.4% of patients. Moreover, the investigators found themselves unable to predict the presence of a perilymph fistula, stating that intraoperative findings were not correlated to the patient’s history or the preoperative diagnosis of tinnitus or vertigo. (A typical history for a round window membrane rupture was not reported by 89.8% of the study’s patients.) [3]

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Physical

See the list below:

  • 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

See the list below:

  • 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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