However, in a later study in which endoscopy was performed just prior to tympanometry in three patients. We report a case of PLF of RW, which was provoked by sneezing, and its consequent medical and surgical treatments. The volume of perilymph is estimated to be approximately 75 microlitres, so confirming a leak usually entails visualizing a tiny quantity of fluid, unless it is dramatic which probably means a CSF leak. When the cause was blunt head trauma the fistula was always at the oval window. Exploration of the right ear revealed a PLF at the fissula ante fenestram and of the floor of the round window niche, and these were repaired with connective tissue. For the literature review, five references were selected. Grimm emphasised that these symptoms can be easily assumed to be postconcussion syndrome.

In a cat model with surgically created round window PLFs intrathecal gadolinium was seen on MRI in the cochlea and ipsilateral mastoid bulla [ 84 ]. High resolution CT can now image normal and abnormal stapes in considerable detail [ 88 ] and has shown a subluxed stapes in an eleven-year-old boy from a traumatic penetrating injury [ 89 ]. Fitzgerald [ 44 ] described five patients with a PLF caused by head injury, whiplash, and gunshot impact. Grimm and colleagues [ 45 ] performed detailed neurological and neurootological studies on one hundred and two adults with mild defined cranio-cervical trauma who had a confirmed PLF. The resolution of temporal bone imaging by computed tomography CT and by magnetic resonance imaging MRI is improving.

Therefore, one was postsurgical and one had an identifiable trauma history.

Congenital and acquired perilymph fistula: review of the literature.

Perilymph fistula PLF is defined as a leak of perilymph at the oval or round window. The perilympn of cochlin-tomoprotein detection test in the diagnosis of perilymphatic fistula. Many authors emphasise that such likely event can be forgotten, or even concealed by the patient.


There are numerous descriptions of clinical balance testing on PLF patients, as variations on the Romberg test. The perilymph fistula syndrome defined in mild head trauma.

Congenital and acquired perilymph fistula: review of the literature.

The theory proposes that a force up an abnormally patent cochlear aqueduct could rupture the basilar membrane and Reisner’s membrane into the scala vestibuli, and conceivably injure the utricle, saccule, the semicircular canal system, the round window membrane, or the annular ligament of the stapes. Of two hundred and forty-six ears with possible posttraumatic PLF ninety had a positive test.

literature review perilymph fistula

Introduction Perilymph fistula PLF has literatude a controversial issue in otolaryngology now for fifty years. Annals of Otology, Rhinology and Laryngology. This observation was developed into an office diagnostic test for PLF when the transtympanic needle is placed in the round window niche. Two papers have focussed on head trauma and whiplash as a cause of PLF.

The resolution of temporal bone imaging by computed tomography CT and by magnetic resonance imaging MRI is improving. Surgical management of perilymph fistulas.

Here, key controversial aspects are discussed with the exception of surgical repair techniques. Rupture of the round window membrane.

literature review perilymph fistula

Intraoperative assessment of perilymphatic fistulas with intrathecal administration of fluorescein. In the bones with hydrops one had a round patent round window fissure and a history of vertigo attacks which had been diagnosed as Meniere’s disease. In animal models of PLF caused by removing or breaching the round window membrane in guinea pigs and cats [ 64 — 67 ] histology and auditory brainstem hearing thresholds suggest that PLFs can heal, that there may be no long-term hearing loss, and sometimes cochlear hydrops is observed.

Sneezing represents a rare but well-recognized cause of PLF, as reported in our case. Advances in imaging are likely to take its place. Protecting the science—an art—of otopathology.

Perilymph Fistula: Fifty Years of Controversy

Effects of persistent perilymph fistula on the inner ear. Vestibular effects of chronic perilymph fistula in the cat. Professor WPR Gibson provided many helpful comments. Microfissure between the round window niche and posterior canal ampulla.


Surgical management of perilymphatic fistulas: In that regard a change on the intraoperative EcochG [ 71 — 73 ] is the most unequivocal test that a window oiterature is present, but it requires special equipment and is unavailable to most. In patients presenting congenital fistula without symptoms or radiologically detectable abnormalities, little malformations of the middle ear may be detected during surgery.

It was first recognized in the early days of stapedectomy as causing disequilibrium and balance problems before sealing of the stapedectomy with natural tissue became routine. A recurring claim is that individuals with a PLF have endolympahtic hydrops in the affected ear [ 9 ], and that this is the reason for their vestibular symptoms, requires some scrutiny.

literature review perilymph fistula

Consequently temporal bone otopathology is now difficult to access. Many hold strong views on its existence or otherwise, the symptoms it might cause, the tests which might predict it, the reliability of what is described on exploration, and the effect of repair on symptoms. Conflict of Interests The author reported no conflict of interests. The anaesthetist was asked to increase the intrathoracic pressure, resulting in recovery of the AP and decrease in the SP when perilymph refilled the otic capsule.

When the cause was barotrauma, exertion or unknown was always at the round window. He has suggested the subtle symptoms of a liteeature PLF make it a neurological syndrome as well as otological.