Perilymph Fistula (PLF)

Perilymph Fistula (PLF) is a tear or defect most commonly affecting the thin membranes separating the air-filled middle ear and the fluid-filled inner ear. This opening enables inner ear fluid, called perilymph, to leak into the middle ear.

When a fistula is present, changes in middle ear pressure directly affect the inner ear, stimulating balance and/or hearing structures sometimes resulting in symptoms, including fluctuating hearing, ear fullness, dizziness and motion intolerance. Symptoms can worsen with changes in altitude, bending over, heavy lifting or coughing or sneezing.

The most common cause of fistula is head trauma, generally involving a direct impact to the head. Other causes include ear trauma, pressure changes from ascent or descent during scuba diving or intracranial pressure from childbirth or weightlifting.

Fistulas may be congenital (present at birth) while others may be the result of invasive middle ear pathologies (cholesteatoma). When symptoms of fistula are present, fistula testing may be completed in conjunction with vestibular assessment to identify if surgical exploration is warranted. After evaluation, the patient and physician must decide whether to undergo surgery to patch the oval and round window areas.