Treating a Perilymph Fistula

A perilymph fistula (PLF) is difficult to identify. It can cause dizziness, hearing loss, and other debilitating symptoms. This condition is often caused by ear trauma or trauma to the head as a result of a car accident or sports injury. When trauma occurs, it can create an abnormal opening between the middle ear and inner ear, resulting in fluid leaking into the middle ear. Everyday activities, such as bending over and riding on an elevator can become increasingly difficult. Chesapeake Ear Nose & Throat in Baltimore, MD, has a board-certified surgeon on staff who can diagnose and treat this condition.

Because a perilymph fistula can often be confused with other ear disorders, such as Ménière’s disease, it is important to visit a specialist as soon as symptoms occur. 


A perilymph fistula occurs when fluid from the inner ear leaks into the middle ear as a result of a tear or defect in the thin membranes between the fluid-filled inner ear and air-filled middle ear.

Because a perilymph fistula can often be confused with other ear disorders, such as Ménière’s disease, it’s important to visit a specialist as soon as symptoms occur. Side effects can range from mild annoyances to complete debilitation and generally include:

  • Dizziness and vertigo
  • Balance disorders
  • Nausea and vomiting
  • Difficulty hearing
  • Sensitivity to loud noises
  • Fullness in the ears
  • Tinnitus (ringing in the ears)
  • Motion intolerance and sickness
  • Elevated symptoms during altitude changes
  • Increased pressure when coughing, sneezing, bending over, or blowing your nose


Although a perilymph fistula can be the result of a birth defect, other common causes include:

  • Direct trauma to the head
  • Ear trauma as a result of infection, surgery, or foreign object
  • Whiplash injury
  • Perforated ear drum
  • Air pressure fluctuations that occur from flying or scuba diving
  • Increased pressure in the head from childbirth or weightlifting


During your initial consultation, the doctor will order a series of tests to determine the cause of your discomfort. A perilymph fistula can often be overlooked or misdiagnosed, which is why it is important to visit a highly trained specialist. At Chesapeake Ear Nose & Throat, we have a board-certified surgeon onsite to diagnose and treat this medical condition. Tests performed include:

  • Fistula Test: During this test, a small rubber bulb is inserted into each canal. After pressurization, the patient’s eye movements will be monitored.
  • Valsalva Test: The patient closes their mouth and pinches their nose while releasing gradual air pressure through their nasal passageways and ears. During the test, the doctor will monitor the eyes and ears to determine if a perilymph fistula may be present.
  • ENG: Also known as electronystagmography, this test determines whether the patient’s dizziness is related to an inner ear infection. During this test, the doctor will connect small electrodes around the nose and monitor eye movements.

If these tests are inconclusive, the doctor may request CT and MRI scans to eliminate other possibilities. If a perilymph fistula is diagnosed, depending on the extent of the issue, the doctor will recommend a conservative treatment approach. This may include medication and at least a week of strict bed rest to give the fistula time to heal. Afterwards, he may recommend certain activities to avoid, such as lifting, bending over, nose blowing, air travel, riding elevators, and loud concert arenas.

If the fistula has not closed within six months, surgery may be necessary to repair the opening. During the procedure, the doctor will administer anesthesia and place a soft tissue graft over the area to promote healthy tissue growth and improved hearing.

Contact Us Today

If you are experiencing symptoms of a perilymph fistula, we recommend visiting our specialist to determine the cause of your symptoms. Detecting a perilymph fistula early can prevent it from growing larger or exacerbating symptoms. To schedule your consultation, contact us online today or call (410) 356-2626.

“I received excellent care at Chesapeake ENT. Their prompt response and cheerful attitudes made for a wonderful experience. All of the audiologists were very helpful. Especially Dr. Laura Toll, her knowledge of hearing aids and the new technology offered made for an easy decision."


- Tanya 

"Was very knowledgeable and helpful."


- Saafir 

"Very courteous and on time."


- Pauline