Perilymphatic fistula

Last revised by Dr Yuranga Weerakkody on 19 May 2021

A perilymphatic fistula (also known as a labyrinthine fistula) is a pathologic communication between the fluid-filled space of the inner ear and the air-filled space of the middle ear, most commonly occurring at either the round or oval window.

Clinical presentation

Symptoms of perilymphatic fistula may include:

  • sensorineural hearing loss
  • vertigo
  • nausea
  • tinnitus
  • spatial disorientation
  • dizziness
  • ear fullness

Radiographic features

CT
  • may demonstrate fluid-filling in the round window (especially if > 2/3 of the round window niche) or in the oval window niches (considered most common sign 6
MRI
  • may demonstrate fluid-filling in the round window (especially if > 2/3 of the round window niche) or in the oval window niches (considered most common sign 6
  • may demonstrate a round window sign
    • defined as a nodular FLAIR high signal in the round window and the presence of associated saccular hydrops 7

 

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Cases and figures

  • Case 1: with automastoidectomy
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