Perilymphatic Fistulas and Post Head Injury Dizziness

If you’ve had a past head injury and currently experience ongoing dizziness that negatively affects your life activities, you may have a perilymphatic fistula (PLF).

A PLF occurs when a head injury causes fluid (perilymph) to leak from the inner ear into the middle ear.  Although there are several tests that can be done to aid in the diagnosis of PLF, none of them are capable of verifying the presence of the condition. Therefore, a high degree of certainty on the practitioner's part combined with a good history, typical symptoms, and positive vestibular testing are sufficient for diagnosis.  Consultation is then sought from a specialist (neurotologist or otoneurologist) to confirm the patient has PLF.

A simple surgery is often necessary to treat perilympathic fistula and is normally performed while the patient is under anesthesia. An operative microscope is used to go through the ear canal into the middle ear to gain access to the inner ear.  There are two areas in the inner ear where the leak can occur.  Both areas are repaired with a small soft tissue graft since the actual source of the leak is seldom observed.  The patient stays overnight in the hospital.  Discharge instructions are to rest for the next three days.  The risk of the operation is minimal and complete or near-complete resolution of dizziness occurs in 98% of cases. 

For further information, refer to: "Persistent Dizziness Following Head Trauma and Perilymphatic Fistula," Fitzgerald, D MD, Archives of Physical Medicine and Rehabilitation, vol 76, no 11, November 1995.