Perilymphatic Fistula

[Fly Girl]

My ENT thinks I might have a perilymphatic fistula in my left ear. As I was coming out of the water when diving last weekend, I developed extreme vertigo. I had a hearing test yesterday that shows nerve damage hearing loss in the affected ear. My ENT is dive savvy, and she is consulting with the other ENTs in the practice for what to do next. For now, I am supposed to take it very easy (she said bed rest) and do no heavy lifting or anything that might cause a strain. She thinks that I should be seen by a doctor that specializes in this at John Hopkins, but she wants to consult the other doctors first (read, I'm Kaiser, and she has to get approval from the Chief of Staff to allow me to go out of plan).

Dr. Mike, Dr. Lynne, or any of the other experts out there, do you have any familiarity with a perilymphatic fistula? My ENT says that they are sort of like the Yeti monster of the ENT world, not everyone believes in them, and she herself is not even certain. She does say though that she is worried about whatever has caused the nerve damage and does not want this to get worse. Does this usually mean the end of diving? Sure, the hearing loss bothers me, but I never want to be as sick as I've been this week with vertigo ever again. Thanks in advance for any thoughts you might have on this.

 

[doctormike]

My ENT thinks I might have a perilymphatic fistula in my left ear. As I was coming out of the water when diving last weekend, I developed extreme vertigo. I had a hearing test yesterday that shows nerve damage hearing loss in the affected ear. My ENT is dive savvy, and she is consulting with the other ENTs in the practice for what to do next. For now, I am supposed to take it very easy (she said bed rest) and do no heavy lifting or anything that might cause a strain. She thinks that I should be seen by a doctor that specializes in this at John Hopkins, but she wants to consult the other doctors first (read, I'm Kaiser, and she has to get approval from the Chief of Staff to allow me to go out of plan).

Dr. Mike, Dr. Lynne, or any of the other experts out there, do you have any familiarity with a perilymphatic fistula? My ENT says that they are sort of like the Yeti monster of the ENT world, not everyone believes in them, and she herself is not even certain. She does say though that she is worried about whatever has caused the nerve damage and does not want this to get worse. Does this usually mean the end of diving? Sure, the hearing loss bothers me, but I never want to be as sick as I've been this week with vertigo ever again. Thanks in advance for any thoughts you might have on this.

Hi, Fly Girl...

Thanks for writing!

We have had a discussion or two about this in the past:

http://www.scubaboard.com/forums/3567404-post6.html

http://www.scubaboard.com/forums/3675102-post16.html

The bottom line is that while it is true that the existence of a SPONTANEOUS perilymph fistula causing sudden hearing loss is controversial (e.g. "do you believe in the fistula fairy?"), there is no question that traumatic perilymph fistula is a very real condition which may require urgent surgery to stabilize hearing, etc... Traumatic fistulae can be caused by external trauma (such as an assault or motor vehicle accident) or middle ear barotrauma. Also, inner ear decompression sickness can have similar symptoms to those of a fistula, so that is another complicating factor.

A spontaneous fistula would present as a sudden hearing loss with no history of trauma, diving, etc... It is diagnosed by opening up the ear at surgery, convincing yourself that you see a little bit of clear fluid near where the leak should be, putting some fat in that area, and then taking credit for the fact that the hearing loss in that ear doesn't get any worse! I'm being a little bit facetious, of course, but that is the basic approach to this condition...

At Hopkins, I would recommend Dr. John Niparko...

Keep us posted!

Mike