A perilymph fistula (PLF) is a tear in either one of the membranes separating your middle and inner ear.

Your middle ear is filled with air. Your inner ear, on the other hand, is filled with fluid called perilymph. Usually, thin membranes at openings called oval and round windows separate your inner and middle ear.

But these membranes can rupture or tear, which can cause perilymphatic fluid from your inner ear to flow into your middle ear.

This fluid exchange can cause pressure changes that affect your balance and hearing.

Symptoms of a perilymph fistula can include:

  • a feeling of fullness in your ear
  • sudden hearing loss
  • hearing loss that comes and goes
  • dizziness or vertigo
  • persistent, mild nausea
  • memory loss
  • motion sickness
  • a sense of being unbalanced, often to one side
  • headaches
  • ringing in the ears

You might find that your symptoms get worse when:

  • you experience altitude changes
  • lift something heavy
  • sneeze
  • cough
  • laugh

Some people don’t experience symptoms, while others have very mild symptoms that are hardly noticeable. Some people report simply feeling a bit “off.”

Keep in mind that perilymph fistulas tend to only affect one ear at a time. However, severe head trauma can lead to bilateral perilymph fistulas in rare cases.

Perilymph fistulas can happen after you experience head trauma or barotrauma (involving extreme and rapid changes in pressure). These extreme pressure changes can occur from a range of things, including air travel, scuba diving, childbirth, and heavy lifting.

Other potential causes include:

  • experiencing whiplash
  • puncturing your eardrum
  • being exposed to very loud sounds, including gunfire or sirens, close to your ear
  • serious or frequent ear infections
  • blowing your nose very hard

Perilymph fistulas can also be present at birth in some cases.

Some people report developing spontaneous perilymph fistulas with no apparent cause. However, in these cases, the root cause could be an old injury or something that didn’t cause immediate symptoms.

It can be difficult to diagnose a perilymph fistula. Symptoms that appear after trauma, such as dizziness, could be linked to other conditions, such as traumatic brain injury with a concussion.

General symptoms of perilymph fistula are also very similar to those of Ménière’s disease, an inner ear disorder that causes balance difficulties and hearing loss. Treatment approaches for the two conditions differ, so it’s important to get an accurate diagnosis from your healthcare provider.

To narrow down the potential causes of your symptoms, they may use a variety of tests, including:

  • hearing tests
  • balance tests
  • CT scans
  • MRI scans
  • an electrocochleography test, which looks at activity in your inner ear in response to sounds in order to determine if there’s an abnormal amount of fluid pressure inside the inner ear
  • a perilymph fistula test, which tracks your eye movements while pressure is applied to the external auditory canal

Usually a combination of your medical history and test results can provide enough information to presumptively diagnose a perilymph fistula. Confirmation may come from an MRI or CT scan or with surgical exploration.

There are several options for treatment, depending on the symptoms you experience.

Bed rest or restricted activity for one to two weeks is sometimes the first approach to treatment. If this leads to improvement, your healthcare provider may recommend further bed rest to see if the improvement continues.

There’s also a fairly new treatment called a blood patch injection that may help. This may be used as the first-line of treatment.

This treatment involves injecting your own blood into your middle ear, which in turn patches up the defective window membrane. A 2016 review looked at 12 cases of suspected perilymph fistula. Symptoms improved for all but one person.

Your healthcare provider might also recommend surgery, especially if other treatments don’t seem to be working.

The procedure generally takes between 30 and 60 minutes. Your eardrum will be lifted through your ear canal so tissue grafts can be placed over the membranes between your inner and middle ear.

Dizziness often improves after surgery, but some research suggests hearing loss may not improve, even with surgery.

After surgery, it’s important to limit your activity for three days. And for the next several weeks to a month, you’ll need to:

  • avoid lifting more than 10 pounds
  • avoid activities that could cause strain, including diving and lifting weights
  • sleep with your head elevated

It’s important to follow all of your healthcare providers’ recommendations after surgery. The recovery period may seem long, but straining the fistula before it fully heals can lead to a persistent fistula.

Diagnosing and treating a perilymph fistula can be challenging, but it’s important to get an accurate diagnosis and treatment. Contact your healthcare provider right away if you experience dizziness and hearing loss, even minor hearing loss, after an ear or head injury.

Some perilymph fistulas heal on their own with rest, but in some cases, you may need a blood patch or surgery. While the procedure itself is fairly quick, it’ll take about a month to fully recover.