A Perilymph Fistula can be described as a tear in one of the membranes separating our middle and inner ear. Our middle ear is filled with air, whiles our inner ear, on the other hand, is filled with a fluid called perilymph. The inner ear and the middle ear are usually separated by thin membranes called oval and round windows. In the event that one or more of these membranes have a tear in them, it causes perilymphatic fluid in the inner ear to flow out into the middle ear. This inadvertent fluid exchange creates a difference in the fluid pressure of the inner ear. The nerves and otolithic organs situated in our inner ear are associated with maintaining our balance while standing, walking, sitting, etc. This difference in fluid pressure in the inner ear leads to balance disorders and hearing problems.
What Are The Symptoms Of Perilymph Fistula?
Perilymph Fistula symptoms include:
- A feeling of fullness in your ear
- Sudden hearing loss
- Inconsistent hearing loss
- Dizziness and/or Vertigo symptoms
- Persistent, mild nausea
- Temporary memory loss
- Motion sickness
- A feeling of unbalance, particularly to one side
- Recurrent headaches
- Persistent ringing in the ears
Perilymph Fistula symptoms can worsen when you’re doing any of these things:
- Experience altitude changes
- Lift heavy things
- Sneeze
- Cough
- Laugh
Some perilymph fistula patients don’t experience any symptoms, while others show mild symptoms that are hardly noticeable. Some people report simply feeling somewhat ‘off’ and not ‘in tune’ with their bodies. Although Perilymph Fistula only affects one ear at a time, in certain cases, severe head trauma can lead to bilateral perilymph fistulas in rare cases.
What Are The Causes Of Perilymph Fistula?
Perilymph Fistula can happen after you experience certain head trauma or barotrauma (a condition that involves extreme, rapid changes of pressure). Several reasons lead to this pressure change; air travel, childbirth, scuba diving, heavy lifting, etc.
Other potential Perilymph Fistula causes include:
- Experiencing whiplash
- Puncture in the eardrum
- Being exposed to loud sounds like gunshots or sirens, very close to your ear
- Frequent, serious ear infections
- Blowing your nose very hard
In some instances, Perilymph Fistula can also be present in a patient since birth.
In some other cases, patients report developing perilymph fistula cases spontaneously, without any immediate or apparent cause. A major cause for these spontaneous cases is usually an old injury to the inner ear membranes, which might not have caused any immediate symptoms at the time of it happening.
Perilymph Fistula Diagnosis Tests
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Primary Perilymph Fistula symptoms also have a lot of similarities to Meniere’s disease, a disorder of the inner ear that causes balance disorders and hearing loss among patients. It’s also easy to confuse its symptoms with Vertigo, another vestibular disease that arises out of a fluid disbalance in the inner ear & causes dizziness, nausea, headache and a spinning sensation among patients.
It’s super important to ensure that your healthcare provider gives you the correct diagnosis, as Perilymph Fistula treatments for other vestibular conditions like Vertigo, Meniere’s disease, etc. are different. Healthcare providers will use a variety of Perilymph Fistula tests to diagnose the causes of Perilymph Fistula in a patient.
Some Of Those Tests Are
- Hearing tests to ascertain the functionality of the patient’s ears
- Balance tests to determine the functioning of the inner ear
- CT Scans
- MRI Scans
- An electronystagmography test, also known as ENG Test. The test looks at your inner ear activity in the context of different sounds to determine if the fluid pressure in your inner ear is abnormal,
- Perilymph Fistula test that keeps track of your eye movements while applying pressure to your external auditory canals
Healthcare providers usually consider a combination of your medical history & test results to determine whether a patient is suffering from Perilymph Fistula accurately. The confirmation often comes from MRI and/or CT scans, sometimes also with a surgical exploration of the affected area.
Perilymph Fistula Treatments
Perilymph Fistula treatments vary according to the symptoms you’re experiencing. At the onset, your doctor might prescribe you something as simple and primitive as bed rest & activity-restriction for about 2-3 weeks to minimize the effects of the symptoms. If this approach helps your symptoms to subside and leads to improvement in your condition, your healthcare provider might continue with this line of treatment. If the above approach doesn’t work for you, then your doctor might try a Perilymph Fistula treatment called the Blood Patch Injection.
The Blood Patch Injection is a fairly new treatment for Perilymph Fistula that involves injecting your own blood into your middle ear to help patch up the broken window membrane between the inner ear & the middle ear. The Blood Patch Injection may also be used as a first-line of Perilymph Fistula treatment in some cases of Perilymph Fistula.
A 2016 research studied 12 Perilymph Fistula patients, all of whom had been given the Blood Patch Injection. The study recorded that all except one of the patients responded positively to the Blood Patch Injection, & showed improvement in their conditions.
Is Surgery Needed For A Perilymph Fistula?
If both of the treatments mentioned above don’t work, your doctor might recommend Perilymph Fistula surgery to help ease your condition. The surgery usually takes between 30-60 minutes, during which your doctor lifts your eardrum through your ear canal so tissue grafts can be placed as a membrane between your inner ear and middle ear. Post-surgery, patients might experience a little dizziness, which may last for up to three days. After three initial days, the perilymph fistula surgery recovery period begins, and you’ll soon be able to experience normal ear functioning. However, it’s important to remark that in certain cases, even Perilymph Fistula surgery might not improve or restore hearing loss in a patient, congenital or post-traumatic. These patients, however, might still experience some relief from dizziness, headache & persistent ringing, with the surgery restoring the fluid pressure in their inner ear. As part of the Perilymph Fistula surgery recovery period, you’re required to take absolute bed rest for three days immediately succeeding the surgery.
You’ll also be directed by your doctor to adhere to these few rules for faster post-surgery recovery:
- Avoid lifting objects heavier than 10 pounds,
- Avoid activities that could possibly cause strain to your nerves, like diving, rock climbing, marathon running, lifting weights, etc.
- Sleep with your head elevated to maintain proper fluid pressure in the inner ear.
You’ll need to stick to these guidelines for at least the next several weeks to a month and sometimes, even more, post your Perilymph Fistula surgery. The recovery period for each individual differs according to their condition and response to the surgery and is usually pegged at 1 month to a few post-surgery. It’s important to follow the guidelines laid out by your healthcare provider strictly for the entire duration of your post-surgery recovery period. Otherwise, your Perilymph Fistula might not fully heal.
This was first published here.