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Perilymphatic Fistula

1. What is a perilymphatic fistula?

A perilymphatic fistula is an abnormal opening between the air-filled middle ear and the fluid-filled inner ear. In most cases, there is a tear or some type of defect in the oval window or round window membranes. In rare cases, superior semi-circular canal dehiscence syndrome causes an abnormal opening is in the bone of the ear (the otic capsule). Perilymphatic fistula can also rarely occur as a late complication of mastoid or cholesteatoma surgery. In these cases, the fistula is caused by repeated infections in the opened mastoid.

2. What causes perilymphatic fistula?

Some perilymphatic fistulas are congenital, that is, present from birth. Those are frequently associated with atresia, microtia, cholesteatoma, and Mondini’s malformation / dysplasia. Other common causes of perilymphatic fistula include head trauma, acoustic trauma, or barotrauma.

3. What are the symptoms of perilymphatic fistula?

The symptoms of perilymphatic fistula vary in severity and complexity and can range from very mild to completely incapacitating. When a fistula is present, changes in barometric pressure such as when flying or diving, will directly affect the inner ear stimulating the hearing and balance structures. These symptoms include dizziness, vertigo, balance problems, nausea and vomiting. Tinnitus and hearing loss are also commonly associated with perilymphatic fistulas. Some individuals find that their symptoms worsen with coughing, sneezing or nose blowing as well as with exertion and activity. Additionally, the symptoms of perilymphatic fistula can overlap the symptoms of other hearing and balance related disorders such as Meniere’s disease.

4. What is the treatment for perilymphatic fistula?

A specialized interdisciplinary team of professionals is necessary to treat all of the issues associated with perilymphatic fistula. This group of individuals should include an Otologist or Otolaryngologist, an audiologist, and possibly a vestibular rehabilitation expert. In some instances, evaluation for potential surgical exploration to make the diagnosis and to provide treatment is recommended. Other times, conservative therapy allows resolution of the problem.

The California Ear Institute is a leading global center for otological, otolaryngological and audiological treatment.Dr. Joseph Roberson, a board certified neurotologist, has performed thousands of successful hearing related surgeries, including many on patients whose hearing impairment is the result of perilymphatic fistula.

5. What are the consequences of avoiding treatment?

Patients must seek medical treatment for any change in hearing or balance regardless of whether or not a perilymphatic fistula is suspected to be the source of the hearing loss. Evaluation for beneficial drug treatment or surgery cannot be established without a comprehensive medical examination and associated testing. Avoiding medical evaluation for perilymphatic fistula or any other hearing or balance impairment related condition is not recommended, and can lead to permanent hearing loss.

Additional notes

Patients searching the internet for information about perilymphatic fistula or any other medical issue should know when reading about individual case histories, that generally it is the patients with the most severe symptoms who either post their own experiences or are included in medical review journals. As a result, it is easy to become overly alarmed and assume the worst. Patients should keep this in mind as they explore the available resources, and look for sources that are certified by HON or other reputable health reviewing organizations. As with all medical conditions, prompt treatment by experienced medical personnel give the best chance for a positive outcome.


If you suspect that you have perilymphatic fistula or you have noticed a change in your hearing or balance, consult a CEI otologist. The outlook for treatment is excellent, once the diagnosis has been made and appropriate treatment is initiated.

Click here to make an appointment with the California Ear Institute to consult with one of our board certified otologists regarding your ear-related condition.

California Ear Institute