Suffering from ongoing dizziness? Midland Hearing Care looks at what is perilymphatic fistula

At Midland Hearing Care we specialise in diagnostic audiology assessments and patient focused care. We recently had an interesting patient case referred to our clinic by an Ear, Nose and Throat Consultant for differential diagnosis.

The patient had sustained an injury after falling from a height and presented with fluctuating hearing loss and ongoing dizziness. A diagnosis of periplymphatic fistula was confirmed.

What is a perilymphatic fistula?

A perilymphatic fistula (PLF) refers to a hole or tear in one of the membranes that separate the middle ear and inner ear. The middle ear is filled with air, while the inner ear is filled with fluid (perilymph). These two areas inside of the ear are separated by membranes. If the membranes rupture, then perilymphatic fluid can flow from the inner ear into the middle ear. The resulting pressure changes can cause balance and hearing problems.

Most of the time, PLFs only affect one ear at a time. A person with a perilymphatic fistula may notice that their symptoms worsen when they laugh, sneeze or cough. Alternatively, they may experience an increase in symptoms when lifting something heavy or changing altitudes during air travel.

Clinical Audiologist at Midland Hearing Care, Jenevieve Butler

What are the symptoms of a perilymphatic fistula?

● Sudden hearing loss
● Hearing loss (fluctuating)
● A feeling of fullness in the ear
● Dizziness
● Motion sickness and nausea
● Balance problems
● Headaches
● Tinnitus

What causes perilymphatic fistulas?

● Head trauma
● Ear trauma
● Barotrauma (rapid changes in pressure due to flying, scuba diving, heavy lifting)
● Exposure to loud noises that are close to the ear, such as gunfire
● Frequent ear infections

How are perilymphatic fistulas diagnosed?

Perilymphatic fistula symptoms are similar to those of other inner ear conditions, such as Meniere’s disease, vestibular neuritis and it is important for the Audiologist and ENT Consultant to rule out these other issues. Here is a list of formal tests used to provide a differential diagnosis:

● Balance tests
● Hearing tests
● Electrocochleography, a test that measures the fluid pressure inside of your inner ear
● A perilymphatic fistula test, which tracks your eye movements while pressure is applied to your ear canal
● In some cases, MRI and CT scans may be combined when diagnosing a perilymphatic fistula

Prevention of Perilymphatic fistulas

● Protect your ears when exposed to loud noise - wear ear protection
● Wear filtered earplugs when travelling by plane - this may help to equalise ear pressure when flying
● Manage ear infections in a timely manner and seek advice from your GP and Audiologist

How are perilymphatic fistulas treated?

Perilymphatic fistulas can cause a range of troubling symptoms that interfere with quality of life. If diagnosed with a perilymphatic fistula, the GP and Ear, Nose and Throat Consultant may recommend bed rest which could help the fistula heal on its own.

If bed rest isn’t enough, surgery may be required. During this procedure, the eardrum is gently lifted and tissue grafts are placed over the damaged membranes between the middle and inner ear. It’s important to closely follow the guidelines given by the Ear, Nose and Throat Consultant to ensure a quick recovery.

We are here to help. Midland Hearing Care offers expertise in diagnostic hearing assessments, custom ear protection solutions and onward referral to private Ear, Nose and Throat Consultants, if required.

Please get in touch. You can find us on Facebook and Google my Business. You can also find more information on Midland Hearing Care's website www.midlandhearingcare.com.

The clinic is open from Monday to Friday from 9am to 5pm, by appointment only. To contact Midland Hearing Care, you can email info@midlandhearingcare.com or call 043 336 8029.