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ISRN Otolaryngology
Volume 2012 (2012), Article ID 281248, 9 pages
http://dx.doi.org/10.5402/2012/281248
Review Article

Perilymph Fistula: Fifty Years of Controversy

Department of Otolaryngology, Head and Neck Surgery, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8011, New Zealand

Received 9 April 2012; Accepted 21 June 2012

Academic Editors: D. C. Alpini, T. S. Karhuketo, and M. V. Nestor

Copyright © 2012 Jeremy Hornibrook. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Perilymph fistula (PLF) is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semi circular canal from cholesteatoma and the superior canal dehiscence syndrome. It was first recognized in the early days of stapedectomy as causing disequilibrium and balance problems before sealing of the stapedectomy with natural tissue became routine. It then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause of PLF. Descriptions of “spontaneous” PLF with no trauma history followed. A large literature on PLF from all causes accumulated. It became an almost emotional issue in Otolaryngology with “believers” and “nonbelievers.” The main criticisms are a lack of reliable symptoms and diagnostic tests and operative traps in reliably distinguishing a perilymph leak from local anaesthetic. There are extensive reviews on the whole topic, invariably conveying the authors' own experiences and their confirmed views on various aspects. However, a close examination reveals a disparity of definitions and assumptions on symptoms, particularly, vestibular. This is an intentionally provocative paper with suggestions on where some progress might be made.