The perilymphatic fistula.

This study attempts to establish clinical criteria that would enable physicians to decide which patients with sudden cochlear and vestibular symptoms should be explored surgically in search of a perilymphatic fistula, in the absence of history indicating trauma to the inner ears. For this purpose, we studied forty-five patients whom we operated on because of suspected perilymphatic fistulas. The patients were into two groups: Group A (twenty patients) had previously undergone stapedectomy. Group B (twenty-five patients) had not undergone surgery in the past. Most of our patients experienced a rather acute onset of vertigo, unsteadiness, hearing loss, and tinnitus. We found no significant difference in the symptoms or signs between the patients who had a fistula and those in whom a fistula was not found, nor between those who underwent stapedectomy previously and those who did not. Most of the patients in Group B (75 percent) with fistula did, however, have a history of some stress or trauma preceding the sudden onset of symptoms. Yet some did not. We had three patients with no such history, nor had they undergone a previous stapedectomy. Basically, we are left with a dilemma: whether or not to explore a particular ear with appropriate symptoms and signs but without a traumatic history--knowing that about a quarter of these patients may have a perilymphatic fistula.