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.) [8]
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.
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.)
