Perilymph fistulas (PLFs) occur after stapedectomy, penetrating temporal bone trauma or barotrauma, secondary to bony erosion (lues, neoplasm, or cholesteatoma), and in some congenital temporal bone abnormalities. Whether spontaneous perilymph fistulas (SPLFs) occur, however, and how common they are, remains unproven.
The symptoms of PLF include conductive or sensorineural (sometimes progressive or fluctuating) hearing loss and vertigo.1-4 This is presumed due to perilymph leakage, although, in animal studies, surgically created roundwindow fistulas do not cause hearing loss, unless a cochlear duct defect is also present.5
Symptoms attributed to SPLFs include hearing loss, tinnitus, aural pressure, and balance disturbance. The SPLFs have been diagnosed in patients with isolated balance disorders and even in asymptomatic patients.6-8 There is no single pathognomonic symptom of SPLF, and there are numerous other causes of all of the symptoms attributed to SPLF.
No good test has been established for preoperative documentation of PLFs.
Calhoun KH, Strunk CL. Perilymph Fistula. Arch Otolaryngol Head Neck Surg. 1992;118(7):693–694. doi:10.1001/archotol.1992.01880070023004
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