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Perilymph Fistula

What is a Perilymph Fistula?

A perilymph fistula is a problem in the inner ear. Perilymph is fluid inside the inner ear. This fluid helps with hearing and balance. A fistula is an abnormal opening between two areas that should not be connected. In a perilymph fistula, there is a small opening or tear in the thin membrane between the air-filled middle ear and the fluid-filled inner ear.

What is Happening in My Body?

Think of the inner ear like a tiny water-filled level. It helps your brain know where your head is in space. With a perilymph fistula, inner ear fluid may leak through a small opening into the middle ear. This can disturb the pressure in the inner ear. When that happens, your hearing and balance signals can become mixed up.

A perilymph fistula may happen after head trauma, a blow to the head, whiplash, ear surgery, heavy straining, flying, or scuba diving. Sometimes, there is no clear cause.

Symptoms may get worse with pressure changes, such as:

  • Flying
  • Scuba diving
  • Heavy lifting
  • Coughing
  • Sneezing
  • Straining
  • Blowing your nose

Because of this, you may feel:

  • Ear fullness
  • Dizziness
  • Vertigo, or a spinning feeling
  • Motion sensitivity
  • Balance problems
  • Ringing in the ear
  • Hearing loss
  • Hearing that changes or feels sensitive

It is important to know:

  • Your symptoms are real.
  • This condition may happen after head trauma or pressure changes.
  • Some cases improve with rest and activity changes.
  • Some people need a blood patch or surgery.
  • Sudden or new hearing loss should be checked right away.

How is Perilymph Fistula Diagnosed?

A perilymph fistula can be hard to diagnose. The opening may be very small, and there is not one simple test that finds every case.

The most important step is telling your provider when your symptoms started and what happened right before they began. This is especially important if symptoms started after a head injury, ear injury, flying, scuba diving, heavy lifting, coughing, sneezing, straining, or blowing your nose.

A hearing test is usually one of the most important tests. It checks for hearing loss or hearing changes that can happen with inner ear problems.

Your provider may also check whether pressure changes make your symptoms worse. Other tests may include balance testing, eye movement testing, VEMP testing, electrocochleography, CT scan, or MRI. These tests can give helpful clues, but they do not always prove that a perilymph fistula is present.

Sometimes, surgery is used when a perilymph fistula is strongly suspected. During surgery, an ear specialist looks for signs of inner ear fluid leaking. If a leak is seen, it can help confirm the diagnosis. However, the leak is not always visible.

In many cases, your provider looks at the full picture: your symptoms, what caused them, your hearing test, your balance tests, your exam, and whether another condition could be causing your symptoms.

An example of a hearing test

What Your Provider May Ask

When you see your clinician, they might ask questions such as:

  • When did your symptoms start?
  • Did symptoms start after a head injury?
  • Did symptoms start after flying, scuba diving, heavy lifting, or straining?
  • Have you had recent ear surgery or trauma?
  • How is your hearing?
  • Do you have ringing or fullness in the ear?
  • What makes your symptoms worse?
  • Do coughing, sneezing, straining, or pressure changes bring on symptoms?

How is Perilymph Fistula Treated?

Treatment depends on your symptoms, hearing changes, and likely cause.

Rest and Activity Changes

After a recent injury, your provider may recommend rest and activity limits. This gives the body a chance to heal.

Your provider may tell you to:

  • Rest for 7 to 14 days
  • Keep your head elevated
  • Avoid heavy lifting
  • Avoid straining
  • Avoid blowing your nose
  • Avoid activities that increase ear pressure
  • Avoid flying or scuba diving until cleared

Blood Patch

If symptoms do not improve, your provider may discuss a blood patch.

During this treatment, a small amount of your own blood is placed into the middle ear. The goal is for the blood to clot and help seal the opening.

Surgical Repair

Some people need surgery. This is often called a tympanotomy.

During surgery, the provider places a small tissue graft over the area of the leak. This helps seal the opening.

What Can I Expect Over Time?

Will I Get Better?

Many people improve with rest, activity changes, a blood patch, or surgery. Surgery often helps dizziness and balance symptoms. Hearing improvement is less predictable.

How Long Will It Take?

It depends. Some people improve in a few weeks with rest. Others take longer, especially if they need a blood patch or surgery.

Can I Live a Normal Life?

Yes. Many people return to normal activities after healing. Your provider will tell you when it is safe to return to exercise, lifting, flying, or diving.

When Should I Get Urgent Medical Care?

Seek urgent medical care right away if you have:

  • New weakness or numbness
  • Trouble speaking
  • Face drooping
  • Double vision
  • A severe or “worst ever” headache
  • Fainting
  • Chest pain
  • Trouble walking without help
  • Repeated vomiting that does not improve
  • New or sudden hearing loss
  • Constant or worsening vertigo
  • A fall with a head injury

Questions to Ask Your Provider

  • Do my symptoms fit with a perilymph fistula?
  • Is my hearing affected?
  • Do I need hearing or balance testing?
  • What activities should I avoid?
  • How long should I follow these precautions?
  • Do I need a blood patch?
  • Do I need surgery?
  • When can I return to work, exercise, flying, or diving?
  • What should I do if my symptoms get worse?

Key Points to Remember

  • A perilymph fistula is a small opening between the middle ear and inner ear.
  • It can affect hearing and balance.
  • It may happen after head trauma, pressure changes, surgery, or straining.
  • Symptoms may get worse with coughing, sneezing, lifting, flying, or diving.
  • Some cases improve with rest and activity changes.
  • Some people need a blood patch or surgery.
  • Sudden hearing loss should be checked right away.

Additional Resources