Skip to main content

Advertisement

SpringerLink
Log in

Perilymphatic fistula

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

A perilymph fistula is an abnormal connection between the inner and middle ear that allows escape of perilymph fluid into the middle ear compartment. The clinical symptomatology that follows leakage of fluid is by and large indistinguishable from a number of other pathologies that affect inner ear function. Definite diagnostic proof of a perilymph fistula remains elusive, and methods of diagnosis remain controversial. Traumatic tears in the oval or round windows remain a major cause of perilymph fistula, yet an index of suspicion in traumatic brain injury frequently remains low. The diagnosis of perilymph fistula must always be considered in the appropriate clinical setting of head trauma, barotrauma, and in patients with unresolved and undiagnosed episodes of recurrent vertigo or hearing loss. Surgical treament with patching of oval and round windows remains the mainstay of therapy for this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Goodhill V: Sudden deafness and round window rupture. Laryngoscope 1971, 81:1462–1474.

    Article  PubMed  CAS  Google Scholar 

  2. Baloh RW, Sakala SM, Honrubia V: Benign paroxysmal positional nystagmus. Am J Otolaryngol 1979, 1:1–6.

    PubMed  CAS  Google Scholar 

  3. Pfaltz CR, Matefi L: Meniere’s disease-or syndrome? A critical review of diagnostic criteria. In Meniere’s Disease: Pathogenesis, Diagnosis and Treatment. Edited by Vosteen KH. New York: Thieme; 1981:1–10.

    Google Scholar 

  4. Cutrer FM, Baloh RW: Migraine-associated dizziness. Headache 1992, 32:300–304.

    Article  PubMed  CAS  Google Scholar 

  5. Brandt T, Dieterich M: Vestibular paroxysmia: vascular compression of the 8th nerve? Lancet 1994, 26:343:798–799.

    Article  Google Scholar 

  6. Grad A, Baloh RW: Vertigo of vascular origin, clinical and electronystagmographic features in 84 cases. Arch Neurol 1989, 46:281–284.

    PubMed  CAS  Google Scholar 

  7. Troost BT: Dizziness and vertigo in vertebral basilar disease. Stroke 1980, 11:413–415.

    PubMed  CAS  Google Scholar 

  8. Wall C 3d, Rauch SD: Perilymphatic fistula pathophysiology. Otolaryngol Head/Neck Surg 1995, 112:145–153.

    Article  Google Scholar 

  9. Schuknecht HF: Pathology of the Ear, edn 2. Philadelphia: Lea and Febiger; 1993.

    Google Scholar 

  10. House JW: The fistula problem in otosclerosis surgery. Laryngoscope 1967, 77:1410–1426.

    Article  PubMed  CAS  Google Scholar 

  11. Emmet R, Shea J: Traumatic perilymph fistula. Laryngoscope 1980, 90:1513–1520.

    Google Scholar 

  12. Barber HO: Positional nystagmus especially after head injury. Laryngoscope 1964, 74:891–944.

    Article  PubMed  CAS  Google Scholar 

  13. Brandt T, Daroff RB: The multisensory physiological and pathologic vertigo syndromes. Ann Neurol 1980, 7:195–203.

    Article  PubMed  CAS  Google Scholar 

  14. Rizer FM, House JW: Perilymph fistulas. The House Ear Clinic Experience. Otolaryngol Head/Neck Surg 1991, 104:239–243.

    CAS  Google Scholar 

  15. Davis RE: Diagnosis and management of perilymph fistula: The University of North Carolina approach. Am J Otol 1992, 13:85–89.

    PubMed  CAS  Google Scholar 

  16. Seltzer S, McCabe BF: Perilymph fistula; the Iowa Experience. Laryngoscope 1986, 94:37–49.

    Google Scholar 

  17. Fitzgerald DC, Getson P, Brasseux CO: Perilymphatic fistula: a Washington, DC, experience. Ann Otol Rhinol Laryngol 1997, 106:830–837.

    PubMed  CAS  Google Scholar 

  18. Shepard NT, Smith-Wheelock M, et al.: Vestibular and balance rehabilitation therapy. Ann Otol Rhinol Laryngol 1993, 102:198–205.

    PubMed  CAS  Google Scholar 

  19. Glasscock ME 3d, Hart MJ, Rosdeutscher JD, Bhansali SA: Traumatic perilymphatic fistula: how long can symptoms persist? A follow-up report. Am J Otol 1992, 13:333–338.

    PubMed  Google Scholar 

  20. Friedland DR, Wackym PA: A critical appraisal of spontaneous perilymphatic fistulas of the inner ear. Am J Otol 1999, 20:261–279. This article offers an elegant and very comprehensive review of the subject. The section on management of fistulas is particularly noteworthy.

    PubMed  CAS  Google Scholar 

  21. Singleton GT: Diagnosis and treatment of perilymph fistulas without hearing loss. Otolarngol Head/Neck Surg 1986, 94:426–429.

    CAS  Google Scholar 

  22. Wall C 3d, Rauch SD: Perilymphatic fistula. In Disorders of the Vestibular System. Edited by Baloh RW, Halmagyi G. New York: Oxford University Press; 1966:396–406.

    Google Scholar 

  23. Daspit CP, Churchill D, Linthicum FH: Diagnosis of perilymph fistula using ENG and impedance. The Laryngoscope 1980, 90:217–223.

    Article  PubMed  CAS  Google Scholar 

  24. Vartianien E, Nuutinen J, Karjalainen S, Nykanen K: Perilymph fistula—a diagnostic dilemma. J Laryngol Otol 1991, 105:270–273.

    Google Scholar 

  25. Black FO, Lilly DJ, Peterka RJ, et al.: The dynamic posturographic pressure test for the presumptive diagnosis of perilymph fistulas. Neurol Clin “Diagnostic Neurotology” 1990, May; 8 No.2:399–410.

    Google Scholar 

  26. Bassiouny M, Hirsch BE, Kelly RH, et al.: Beta 2 transferrin application in otology. Am J Otol 1992, 13:552–555.

    PubMed  CAS  Google Scholar 

  27. Weber PC, Kelly RH, Bluestone CD, Bassiouny M: Beta-2-transferrin confirms perilymphatic fistula in children. Otolaryngol Head Neck Surg 1994, 110:381–386.

    PubMed  CAS  Google Scholar 

  28. Rauch SD: Transferrin microheterogeneity in human perilymph. Laryngoscope 2000, 110:545–552.

    Article  PubMed  CAS  Google Scholar 

  29. Evanson MJ, Desloge RB, Parisier SC: Beta-2-transferrin: limitations of use as a clinical marker for perilymph. Laryngoscope 1996, 106:159–161.

    Article  Google Scholar 

  30. Teilan SA, Disher MJ, Sun Q, et al.: Biochemical markers for identification of human perilymph. Abstr Am Otol Soc 1998, 131:39. This article is provocative, however, the jury is still out on the efficacy of this as a putative diagnostic test for perilymph fistula.

    Google Scholar 

  31. Gibson WP: Spontaneous perilymphatic fistula: electrophysiologic findings in animals and man. Am J Otol 1993, 14:273–277.

    PubMed  CAS  Google Scholar 

  32. Meyerhoff WL, Yellin MW: Summating potential/action potential ratio in perilymph fistula. Otolaryngol Head Neck Surg 1990, 102:678–681.

    PubMed  CAS  Google Scholar 

  33. Poe DS, Rebeiz EE, Pankratov MM: Evaluation of perilymph fistulas by middle ear endoscopy. Am J Otol 1992, 13:529–533.

    PubMed  CAS  Google Scholar 

  34. Weissman JL, Weber PC, Bluestone CD: Congenital perilymphatic fistula: computed tomographic appearance of middle ear and inner ear anomalies. Otolaryngol Head/Neck Surg 1994, 111:243–249.

    Article  CAS  Google Scholar 

  35. Buckingham RA, Valvassori GE: Inner ear fluid volumes and the resolving power of magnetic resonance imaging: Can it differentiate endolymphatic structures? Anal Otol Rhino Laryngol 2001, 110:113–117.

    CAS  Google Scholar 

  36. Morris MS, Kill J, Carvlin MJ: Magnetic resonance imaging of perilymphatic fistula. Laryngoscope 1993, 103:729–733.

    Article  PubMed  CAS  Google Scholar 

  37. Rupa V, Rajsatkhar V, Weider DJ: Syndrome of recurrent meningitis due to congenital perilymph fistula with two different clinical presentations. Int J Pediatr Otorhinolaryngol 2000, 54:173–177.

    Article  PubMed  CAS  Google Scholar 

  38. Snyder BD, Boies LR, Ulvestad RF, Mc Guiness PA: Delayed meningitis following stapes surgery. Arch Neurol 1979, 36:174–175.

    PubMed  CAS  Google Scholar 

  39. Maitland CG, Chu FC: Oscillopsia produced by sound and air pressure change. Presented at the Frank B. Walsh Society Meeting, The Cleveland Clinic Foundation, Cleveland, 1984, February 24.

  40. Minor LB, Solomon D, Zinreich JS, et al.: Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Otolaryngol Head/Neck Surg 1998, 124:249–258. This article nicely details symptomatology and pathophysiology defined by computed tomography scanning of a heretofore unrecognized cause of recurrent vertigo. This entity may prove to be not uncommon and may escape detection by conventional tests for perilymph fistula.

    CAS  Google Scholar 

  41. Struppe M, Eggert T, Straube A, et al.: “Inner Perilymph Fistula” of the anterior semicircular canal. A new disease picture with recurrent attacks of vertigo. Nervenarzt 2000, 71:138–142.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tallahassee Neurological Clinic PA, Florida State University College of Medicine, 1401 Centerville Road, Suite 510, 32308, Tallahassee, FL, USA

    Charles G. Maitland MD

Authors
  1. Charles G. Maitland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maitland, C.G. Perilymphatic fistula. Curr Neurol Neurosci Rep 1, 486–491 (2001). https://doi.org/10.1007/s11910-001-0111-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-001-0111-x

Keywords

Search

Navigation