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Health & Diving
Ears & Diving

Ears & Diving

Perilymph Fistula

A perilymph fistula is a tear in the round- and/or oval-window membranes through which inner-ear fluid (perilymph) is leaking.


Mechanism

Leakage of perilymph from the labyrinth may occur when the round or oval window is disrupted due to severe middle-ear barotrauma or forceful Valsalva maneuver.

Manifestations

The symptoms of perilymph fistula may include dizziness, vertigo, imbalance, nausea and vomiting. Some people experience ringing (tinnitus) and fullness in the ears, and many notice some hearing loss. Symptoms worsen with changes in altitude (elevators, airplanes or travel over mountains), weather changes and with physical exertion.

Management

This condition can usually be managed conservatively with absolute bed rest in the sitting position. Straining, sneezing, nose blowing, sexual activity, loud noises and middle-ear equalizing should be avoided to prevent pressure waves in the inner ear.

The round-window fistula often heals spontaneously within a week or two with this regimen, but if hearing loss progresses or the other features persist, it may be necessary to resort to surgery to repair the round-window leak.

Fitness to Dive

Even after the acute symptoms of an oval- or round-window fistula have resolved, the diver's future in diving is questionable. Flying should be completely avoided for several months to allow complete healing of the injury or the surgical repair.

For a referral in your area, email medic@dan.org, or call the DAN Medical Information Line at +1-919-684-2948.

Prevention

Ensure the Eustachian tubes are functioning properly before diving by gently equalizing on the surface.

Prevention

Further Reading

More Questions? Ask a DAN Medic