Persistent dizziness following head trauma and perilymphatic fistula

doi:10.1016/S0003-9993(95)81041-2

Archives of Physical Medicine and Rehabilitation

Volume 76, Issue 11, November 1995, Pages 1017-1020

https://doi.org/10.1016/S0003-9993(95)81041-2 Get rights and content

Abstract

A growing body of evidence supports the idea that dizziness that persists for months and even years can be caused by an unsuspected perilymphatic fistula. Perilymphatic fistulas are abnormal ruptures that allow perilymph to leak out of the inner ear into the middle ear space. Most commonly, these ruptures occur secondary to a traumatic event. The term postconcussive syndrome has been used to describe a myriad of symptoms following head trauma. Some of these symptoms, such as cognitive changes, tinnitus, neck stiffness, and dizziness, are also commonly caused by active perilymphatic fistulas. This article discusses the typical history and diagnostic tests for patients with perilymphatic fistula. Common diagnostic tests include audiograms, electronystagmograms, electrocochleograms, and subjective and platform fistula tests. Also, the surgical treatment for the perilymphatic fistula (ie, repair of the oval and round windows) is reviewed, along with the results produced by this relatively minor car operation. Suggestions are made to help the medical professionals involved in rehabilitative care to be aware of perilymphatic fistulas and seek proper consultations from inner ear specialists if they suspect the existence of this easily cured disorder.

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Cited by (25)

Perilymphatic fistula of the round window after whiplash injury: Another cause of inner ear conductive hearing loss
2014, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Citation Excerpt :
There is no report so far describing PLF in the area of round window following whiplash injury. Fitzgerald [8] described a 35-year-old woman who had undergone a previous repair of PLF of undetermined origin and eight months later, the car she was driving was struck from behind, resulting in whiplash injury associate with immediate dizziness; as the fistula test, which had become negative after her first PLF repair was again positive, she underwent a successful revision repair of PLF. However, details of the operation were not cited and the site of PLF was not reported.
Perilymphatic fistula is usually associated with sudden or fluctuating sensorineural hearing loss. We present a case of whiplash injury in a patient who showed conductive hearing loss at low frequencies due to a perilymphatic fistula occurring in the round window. Although no middle ear pathology was found, the symptoms and laboratory findings were mimicking the so called “third mobile window” phenomenon, but without the presence of inner ear dehiscence. Following early surgical exploration with patching of the round window the hearing was restored and the patient was free of symptoms.
Multidetector CT of Temporal Bone Fractures
2012, Seminars in Ultrasound, CT and MRI
Citation Excerpt :
When vertigo is associated with fluctuating hearing loss, the possibility of a perilymphatic fistula or endolymphatic hydrops should be considered. This abnormality may arise from injury to the round window or oval window membranes, or to the endolymphatic duct itself within the vestibular aqueduct.37-40 Positive imaging findings are seldom encountered.
Temporal bone fracture is a relatively common finding among trauma patients. Before the development of high-resolution multidetector computed tomography (MDCT) imaging, fractures of the skull base and temporal bone were a challenge to diagnose clinically. With current imaging technology, most such fractures are easily detected, and the challenge now lies in predicting the severity of injury and possible complications. In this review, we discuss the detection and classification of temporal bone fractures, their distinction from pseudofractures, and the role of imaging in establishing prognosis, particularly with respect to complications.
Efficacy of vestibular rehabilitation
2000, Otolaryngologic Clinics of North America
Citation Excerpt :
Patients with suspected perilymphatic fistulas with stable hearing were provided with rapid head movements, and 63% of the patients improved.66 In contrast, Fitzgerald used physical therapy for patients with remaining symptoms after surgical repair.19 Shepard et al report that head injury can make rehabilitation more difficult, although they did report that persons with central and combined central/peripheral vestibular disorders did get better with physical therapy.59
Dizziness
1998, Emergency Medicine Clinics of North America
Dizziness is a commonly encountered complaint in the emergency department (ED) and accounts for approximately 1.5% of all hospital admissions.13, 35, 40 In one survey, 26% of all ED patients stated that they had experienced dizziness.²⁸ Dizziness may be the most common non–pain-related physical complaint seen in the ED. In primary care practices, it is reported that dizziness accounts for 8 million outpatient visits per year in the United States.⁴⁰ In fact, all people experience dizziness at some point during their lives. If dizziness is so frequently encountered, what precipitates a patient with dizziness to present to the ED? There are two primary reasons why people experiencing dizziness present to the ED: (1) it interferes with their normal daily activities, and (2) the patient is concerned that they might have a serious underlying disease process.41, 51
Dizziness is uncommon in children, but becomes more common in adults as a function of age. In fact, dizziness affects more than 50% of elderly patients and is the commonest complaint of patients over 75 years of age.²⁶ In the elderly, dizziness can lead to falls and significant injuries. When troubled by dizziness, older patients often refrain from physically strenuous activities, social events, and travel. Accordingly, a fear of dizziness can cause these senior citizens to withdraw socially and facilitate their functional decline.8, 25
For many emergency physicians, the clinical evaluation of dizziness is a difficult and perplexing task. The primary reason for this frustration is because dizziness is a nonspecific symptom that describes a subjective sensation that is virtually impossible to objectively measure. Patients use the term dizziness to describe a perception of altered variation in spatial awareness.³ This perception ranges from a general sense of illness, to fatigue, weakness, lightheadedness, fainting, disequilibrium, or an illusion of motion (vertigo). The cause of these perceptions can range from labyrinthitis to cerebral hemorrhage to cardiac arrhythmias to orthostatic hypotension to volume depletion. It is readily apparent to the clinician that the ability to rapidly focus on one organ system dysfunction to explain or account for the patient's presentation is not possible—especially in the aged. Multiple systems maintain the proper perception of the relationship between the person and the environment. These systems include the vestibular, visual, and proprioceptive systems. Accordingly, the differential diagnosis can be quite lengthy. Regretfully, there is no quick and simple method to identify patients, especially older patients, at risk for “serious” causes of dizziness.
The purpose of this article is to present a systematic approach to the evaluation and management of the dizzy patient from the perspective of the emergency physician, with an emphasis on a management strategy that is timely and cost effective. Subsequently, obtaining a precise and accurate history and physical examination cannot be stressed enough, because in the evaluation of this complaint, laboratory tests and imaging studies are of little, if any, diagnostic value. The first portion of the article focuses on adults, particularly the geriatric patient, and the second portion of the article concentrates on pediatric patients.
Perilymphatic Fistula
2023, Third Mobile Window Syndrome of the Inner Ear: Superior Semicircular Canal Dehiscence and Associated Disorders
Frequency of peripheral vestibular pathology following traumatic brain injury: a systematic review of literature
2021, International Journal of Audiology

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Clinical notePersistent dizziness following head trauma and perilymphatic fistula

Abstract

Am J Otolaryngol

Vestibular rehabilitation: an exercise approach to managing symptoms of vestibular dysfunction

Semin Hearing

Inner ear concussive syndrome, vestibular implications and physical therapy treatment

Top Acute Care Trauma Rehabil

Facilitation, inhibition, and habituation of the vestibular response

Adv Otorhinolaryngol

Treatment of vestibular disorders in traumatically brain-injured patients

J Head Trauma Rehabil

The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo

Otolaryngol Head Neck Surg

Physical therapy for benigh paroxysmal positional vertigo

Arch Otolaryngol

Curing the BPPV with a liberatory maneuver

Adv Otorhinolaryngol

Vertigo after head injury–a five year follow-up

J Otolaryngol

Perilymph fistula: the Iowa Experience

Laryngoscope

Surgical management of perilymphatic fistulas: a Partland Experience

Am J Otol

Perilymph fistula: The Stanford Experience

Ann Otol Rhinol Laryngol

Traumatic perilymphatic fistula

Arch Otolaryngol

Clinical note
Persistent dizziness following head trauma and perilymphatic fistula