How is perilymph fistula treated?

perilymph fistula

A perilymph fistula, also called PLF, is a tear in any one of the membranes separating your inner & middle ear. Your middle ear is filled with air, as opposed to the inner ear which is filled with a fluid called perilymph. Usually, the inner ear & the middle ear are separated by thin membranes at openings called oval & round windows. However, these thin membranes are prone to rupture or tear, which then causes the perilymph fluid inside the middle ear to flow into the inner ear. This fluid exchange can cause pressure changes inside the ears that can affect your balance & hearing. This condition is called Perilymph Fistula. Here is the knowledge about the Perilymph Fistula Symptoms, causes & treatment.

Perilymph Fistula Symptoms:

Perilymph Fistula symptoms can include:

  • A feeling of fullness inside the ear,
  • Sudden, unexplained hearing loss,
  • Infrequent hearing loss that comes & goes,
  • Dizziness or Vertigo,
  • Mild nausea that is persistent in nature,
  • Memory loss,
  • Motion sickness,
  • A sense of feeling unbalanced, often tilting to one side,
  • Headaches,
  • Ringing sound in the ears also called tinnitus

These perilymph fistula symptoms might get worse for patients if they:

  • Experience altitude changes,
  • Lift something heavy,
  • Sneeze,
  • Cough,
  • Laugh

It’s also important to note that for some patients, perilymph fistula symptoms aren’t present prominently. Some patients might have very mild symptoms that are barely noticeable, while some others report feeling just a bit “off”, Perilymph Fistula cases usually only affect one of the ears. However, in some cases, severe head trauma can cause bilateral perilymph fistula as well.

Perilymph Fistula Causes:

Cases of Perilymph Fistula can happen after you experience head trauma or barotrauma, the latter of which is basically extreme & rapid changes in pressure. These extreme pressure changes can occur due to any of the following activities; air travel, scuba diving, childbirth, & any heavy lifting.

Other potential perilymph fistula causes include:

  • Experiencing any whiplash,
  • Puncturing the eardrums,
  • Being exposed to very loud sounds, including gunfire or sirens close to your ear,
  • Serious or frequently occurring ear infections,
  • Blowing your nose very hard

In some cases, perilymph fistula can also be present since birth. Sometimes, patients present with perilymph fistula that seems to develop spontaneously & all of a sudden. However, in most of these cases, the real reason is often an undiagnosed old injury that didn’t cause any immediate symptoms at the time.

Perilymph Fistula diagnosis: 

Perilymph Fistula diagnosis can prove to be difficult for doctors. This is due to the fact that some perilymph fistula symptoms like dizziness, etc., could be linked to other trauma-related injuries like concussions. Along with that, doctors also have problems with perilymph fistula diagnosis as most of the perilymph fistula symptoms also resemble those of Meniere’s Disease.

It’s also possible for doctors to give out mistaken Vestibular Paroxysmia diagnosis to patients, as most of the Perilymph Fistula symptoms also resemble those of other Vestibular disorders.

For accurate perilymph fistula treatment, it is important to get a proper diagnosis done for the patient’s exact condition. As treatment approaches for various vestibular disorders differ, it is of utmost importance for doctors to accurately diagnose the patient’s condition. Doctors might use a variety of diagnostic tests for an accurate perilymph fistula diagnosis. These tests include:

  • Hearing tests,
  • Balance tests,
  • CT scans,
  • MRI scans,
  • An electrocochleography test(ECG test), which tracks your inner ear activity in response to any sound to determine if there is any abnormal amount of fluid pressure inside the ear,
  • A perilymph fistula diagnosis test, which tracks your eye movement while pressure is applied to the external auditory canal,
  • BPPV & other types of vertigo can be ruled out by various tests like the Dix-Hallpike maneuver, the Subjective Visual Vertical diagnosis (SVV test), etc.

Usually, a preemptive perilymph fistula diagnosis can be reached using a combination of the patient’s medical history & test results. To confirm the perilymph fistula diagnosis, a CT or an MRI scan is required, along with some surgical exploration.

Perilymph Fistula Treatment: 

There are various perilymph Fistula treatment options available for patients, subject to the particular symptoms they experience. The first line of perilymph fistula treatment is often bed rest & a stoppage of any stress-inducing & symptom triggering activities. If this approach shows some improvement, then your doctor might suggest continuing the treatment plan for further relief. Aside from rest & restricted activity, there is also a fairly new line of treatment called the Blood patch injection. It is said to be extremely effective in perilymph fistula treatment, & is sometimes also the first-line of treatment.

In this treatment, the doctor injects your blood into the middle ear, which helps fix the ruptured window membrane between the inner ear & the middle ear.  Blood patch injections work for about 90% of all perilymph fistula patients, & the results are usually permanent. Aside from these treatments, some cases of Perilymph Fistula might also need surgery. If this happens, it’s usually due to the fact that every other perilymph fistula treatment failed to show results. In the surgery, the doctor places tissue grafts over the membrane between the inner ear & the middle ear by lifting up your eardrum. The surgical procedure usually takes about 30 to 60 minutes to complete, & relief is usually temporary.

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