Fistula Case 2
(round window perilymphatic fistula of the inner ear)
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A 33 year old man complained of vertigo. This were preceded by considerable diving. Five years prior to being evaluated, he had dizziness for a week following a 60-ft dive. A year later, he developed dizziness after a shallow dive. 3 years ago, he developed dizziness after returning from an international flight. He was diagnosed as having labyrinthitits. A year later, he developed dizziness, again after a descent in an airplane. Two years go, while taking a trip on the subway, his ears "popped", and he developed a "giant vertigo experience".
He was thought by several clinicians to have a perilymphatic fistula, and was operated on by a well known ear surgeon. According to the operative report, no fistula was seen, but a graft was placed.
Symptoms continued to gradually worsen and made him so ill that he was unable to travel by air due to fear of flying.
Testing was done --
- Audiometry showed normal hearing on both sides, but slightly worse on the right. Audiometry is usually symmetrical in persons with fistulae associated with airplane induced barotrauma.
- A CT scan of the temporal bone was negative. CT scans are nearly always normal in persons with PLF.
Management and course
Insertion of a ventilation tube was recommended, but not acted upon. Verapamil was found to be helpful in reducing motion sensitivity. After several years, he was reexplored and a large RW fistula was found and repaired. All symptoms resolved at that point.
Points:
- Diving is a risk factor for perilymph fistula
- The diagnosis of fistula is primarily based on history
- Reliable dizziness following airplane flight suggests fistula.
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