Perilymph Fistula in Emergency Medicine Follow-up

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

Further Outpatient Care

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  • 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

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Further Inpatient Care

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  • 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.

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Complications

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  • 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.

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Prognosis

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  • 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.

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