Perilymphatic fistula

Perilymphatic Fistula

A Perilymphatic Fistula (PLF) is a medical condition characterized by an abnormal communication between the middle ear and the inner ear. This condition can lead to a variety of symptoms, including vertigo, tinnitus, and hearing loss.

Etiology

Perilymphatic fistulas can occur as a result of trauma, surgery, or may be congenital. Trauma can be either barotrauma, such as that caused by changes in atmospheric pressure, or physical trauma to the ear. Surgical causes include complications from stapedectomy, a surgical procedure to improve hearing. Congenital perilymphatic fistulas are rare and are usually associated with other anomalies of the ear.

Pathophysiology

In a perilymphatic fistula, there is a tear or defect in the thin membranes (the oval window or the round window) that separate the middle ear from the inner ear. This allows perilymph, the fluid that normally fills the space in the inner ear, to leak into the middle ear. This leakage can cause changes in the pressure within the inner ear, leading to symptoms such as vertigo and hearing loss.

Diagnosis

Diagnosis of a perilymphatic fistula can be challenging, as the symptoms can be nonspecific and may overlap with other conditions such as Meniere's disease or vestibular neuritis. Diagnostic tests may include audiometry to assess hearing loss, vestibular testing to evaluate balance function, and imaging studies such as CT scan or MRI to visualize the structures of the ear. In some cases, the diagnosis can only be confirmed during surgery.

Treatment

Treatment for a perilymphatic fistula typically involves surgery to repair the fistula. This is usually done through a procedure called a tympanotomy, in which the surgeon accesses the middle ear through an incision in the eardrum. The fistula is then sealed with a patch made from tissue taken from the patient. Following surgery, patients are usually advised to avoid activities that could increase pressure in the ear, such as heavy lifting or flying, until the ear has fully healed.

See also

• Oval window
• Round window
• Meniere's disease
• Vestibular neuritis