Perilymph Fistula Treatment

Inside the ear, there is a small membrane called the oval or round window that separates the inner ear, which is filled with fluid, from the middle ear. A tear in this membrane is caused a perilymph fistula. It is caused primarily by head trauma, though changes in pressure in the head (such as those incurred while scuba diving) and ear infections are possible culprits. Treatment is relegated to either bed rest or, in severe cases, surgery.

Symptoms

• Balance issues, caused primarily by middle ear pressure changes that affect the inner ear, are the main symptom associated with a perilymph fistula. These balance issues may be accompanied by vertigo, dizziness, nausea and, occasionally, vomiting. Tinnitus, or ringing in the ear, coupled with a loss of hearing, can occur. Strenuous exercises and an increase in altitude can exacerbate the symptoms and should therefore be avoided until the fistula has been repaired.

Medical and Home Treatment

• Simple bed rest, accompanied with keeping the head elevated, is the first recommended method of treatment for a perilymph fistula. Depending on the severity of the fistula, this treatment may be followed for 5 to 7 days which usually leads to complete healing. If a follow-up exam reveals the fistula still to be present, surgery may be suggested to repair it. If flying, using ear plugs helps because they reduce the fluctuation of pressure in the ear. Some medications might be recommended, such as the tranquilizer diazepam, more commonly known as Valium, and lorazepam.

Surgery

• Most physicians prefer to perform surgery only if symptoms do not clear up after a month, while others prefer to perform surgery only if the underlying cause of the fistula is due to trauma or surgery, according to Troy Callender, MD, in an article on the Baylor College of Medicine website (see link in References).

  Surgery typically involves exploring the middle ear and looking for a clear fluid in the window niches. Getting an adequate view of the fistula itself may require a number of specialized techniques, such as trendelenburg, internal jugular vein compression and valsalva. Even if a fistula is not found, sealing the tissue with either fascia (connective tissues), fat, loose areolar tissue or perichondrium (connective tissue surrounding cartilage) is recommended, as the fistula may just be too small to see.

Ventilation Tube

• Another form of surgical treatment is the use of a ventilation tube. Referencing a 2003 issue of "Otology & Neurotology," Timothy Hain, MD, on Dizziness-and-Balance.com states that the ventilation tube, which reduces the pressure and movement of the tympanic membrane of the middle ear (ear drum), is necessary to alleviate the effects caused by a fistula or other damage (see link in Resources).

Endoscopic Guided Repair and Shunts

• Another form of surgery includes fistula repair guided by an endoscope (not recommended due to limited line of sight), and the use of a shunt. According to a 2006 article found in the "Journal of Neurosurgery," a shunt can be beneficial in those with crippling headaches, vertigo and tinnitus caused by perilymphatic fistulas, though Hain reports they are only considered in extreme cases and the procedure is not widely available (see link in Resources).

  A study published in the November 2001 issue of "Otology & Neurotology" showed that "endoscope-guided round window repair," which uses a myringotomy (ear drum incision) and a tympanoscope, was an effective and minimally invasive method of locating fistulas and assessing the need for repair of perilymph fistulas.