Medical Specialties

At the Center for Neurosciences, we work together across specialties to provide the best, most comprehensive approach to treatment.

Perilymph Fistula

A perilymph fistula (PLF) is an abnormal communication between the middle and inner ears, typically resulting from tears in the oval or round windows. When there is an abnormal opening, perilymph (fluid found within the inner ear) leaks into the middle ear space. PLFs are most commonly caused by head trauma; however, other etiologies include barotrauma, congenital PLF (present at birth), cholesteatoma-related bone erosion, and prior ear surgery. Symptoms of PLF include: chronic imbalance along with episodes of true vertigo (a feeling of spinning when you are not moving) caused by bending/straining, nausea, vomiting, progressive hearing loss, non-pulsatile tinnitus, and a feeling of fullness in the affected ear. In some cases, Tullio’s phenomenon (sound-induced vertigo) may also be experienced.

Diagnosis of a PLF can be challenging, especially when there is no history of ear barotrauma. This is because the symptoms are non-specific, similar to other inner ear conditions such as Meniere’s disease (insert link). Workup includes audiometric (hearing) testing, balance testing, and fistula tests that record eye movements in response to changes in ear canal pressure or sound levels. A CT or MRI scan may also be indicated. Often the diagnosis is confirmed only by surgical exploration of the middle ear.

Bed rest is often recommended to allow the fistula time to heal on its own. Activities that are discouraged include: air travel, lifting/straining, blowing the nose, bending over, and any other activities that may cause changes in pressure within the inner ear. Medications may be prescribed to reduce symptoms of nausea and vomiting. For PLFs that fail to heal on their own (especially those causing progressive sensorineural hearing loss or vertigo), surgical repair with use of tissue grafts to close the hole is recommended.

Why Choose Us

  • Dr. Abraham Jacob, Medical Director for Ear & Hearing (E&H) at the Center for Neurosciences (CNS), is fellowship trained in Otology, Neurotology, and Cranial Base Surgery. He is the first and most experienced Neurotologist in Tucson.
  • Dr. Jacob was a founding member of the University of Arizona (UA) Department of Otolaryngology prior to his departure and transition to CNS. At UA, he was Vice Chair of ENT and held the rank of full Professor with Tenure. He has an international reputation as an expert for treating ear diseases.
  • Dr. Jacob transitioned his practice to the Center for Neurosciences in early 2017 as he felt that the new environment helped him to optimize delivery of personalized ear and lateral skull base care.
  • Exploration of the middle ear with PLF repair is a technically challenging operation that should only be performed by surgeons working in the ear regularly. Dr. Jacob’s surgical practice is limited to ear and lateral skull base. As such, he has performed more complex ear surgery than any other ENT surgeon in Tucson. This clinical experience maximizes his chances of success while minimizing the likelihood of surgery-induced sensorineural hearing loss.