Fistula Case

(perilymphatic fistula of the inner ear)

Timothy C. Hain, MD  

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A middle aged woman who complained of vertigo. This is in the context of some fluid in her right mastoid. Her symptoms began in January. She flew and was on a rather bumpy flight. She became ill and on the way back became even more ill. She was diagnosed as having fluid in her ear and was given steroids for two weeks. Since that time, she has had constant trouble with dizziness, spinning, tilting, rocking, nausea, jumping vision, lightheadedness, and a headache. She cannot focus on moving things, and she gets dizzy when she moves too much. Lying down relieves her dizziness.

Otologically, there are crackling noises on both sides, bilateral fullness, and bilateral ear pain. The right is worse than left.

On examination, under video Frenzel's goggles, there was no spontaneous nystagmus, positional nystagmus, or vibration-induced nystagmus. Tullio's test was negative for fistula. There was, however, some subjective vertigo with Valsalva. This is suggestive of a fistula.


Audiometry prior to surgery showed a mild low frequency sensorineural reduction

Audiometry is usually symmetrical in persons with fistulae associated with airplane induced barotrauma.

The VEMP test was overall normal, but had an unusual configuration on the right.

There is no literature concerning VEMP's in fistula.


ECochG was asymmetrical, with a larger SP/AP ratio on the right side

In our experience, ECochG's may be asymmetrical, but rarely does the SP/AP ratio exceed 0.5.

A ventilation tube was put into the right ear, with improvement.

This woman had her ear explored, and a fistula was found on the left. It was repaired with relief of symptoms. However, they returned after several months. The ear was opened again and the repair redone. She is now nearly asymptomatic.

Hearing is slightly reduced on the right operated side, compared to the left unoperated side, following surgery.


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