A perilymph fistula is an opening or defect in one or both of the miniscule membranes separating the inner ear’s fluid-filled perilymphatic space and the middle ear’s air-filled space. This opening allows perilymph fluid to leak into the middle ear. It is most often caused by a direct blow to the head or, sometimes, by whiplash. It can also be caused by trauma to the ear, sudden changes in pressure, such as with scuba diving or airplane descent, and by sudden changes in intracranial pressure, which may occur during weightlifting or childbirth.

Middle ear air pressure changes, like the popping experienced in flights, are not normally problematic for the inner ear. However, when middle ear pressure changes in someone with a fistula, adverse symptoms result in the balance and/or hearing mechanisms.

Symptoms of perilymph fistula typically include a sensation of ear fullness or pressure, sensitive or fluctuating sense of hearing, dizziness, motion intolerance, sudden loss of hearing, or vertigo. Due to the connection between the inner ear’s perilymphatic space and the brain’s cerebrospinal fluid (CSF), changes in altitude, heavy lifting or straining, bending, coughing or sneezing can all exacerbate symptoms of a PLF. Headaches are a common complaint due to the pressure created by CSF leaking into the perimlymphatic space.

PLF patients can feel frustrated because, while they may look fine from the outside, internal symptoms are still present, and family and friends may have difficulty understanding what is happening. Having a patient and understanding support network is important while coping with persistent dizziness and while exploring diagnosis and treatment options.

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