References: TBI Dizziness; Volume 3 Issue 6

1. AUTHOR	Glasscock-M-E, Hart-M-J, Rosdeutscher-J-D, Bhansali-S-A.
INSTITUTION	Otology Group, P.C., Nashville, Tennessee 37203.
TITLE	Traumatic perilymphatic fistula: how long can symptoms persist? A follow-up report.
SOURCE	Am-J-Otol 1992 Jul, VOL: 13 (4), P: 333-8, ISSN: 0192-9763.
ABSTRACT	In the past 18 years 68 ears (average 3.8 per year) were explored for perilymphatic fistula (PLF). A total of nine (13%) ears had a fistula identified at operation. Patients with a previous history of otologic surgery were excluded from this review. The most common etiology for PLF was head trauma (4 of 9). Most patients had persistent symptoms lasting months (average 6.7). Eighty-three percent of all patients had sudden or fluctuating hearing loss, 77 percent had vertigo or dysequilibrium, and 61 percent had tinnitus. Vertigo was the most commonly improved symptom postoperatively, and only 25 percent of patients had improved hearing. There were no major complications. The authors discuss indications for operation, criteria for diagnosis of PLF, and audiometric and electronystagmographic findings. This report agrees with other recent data indicating that exploration for fistula is an uncommon procedure performed by otologists. Author.

2. AUTHOR	Fitzgerald-D-C.
INSTITUTION	Department of Otology/Neurology, Washington Hospital Center, Washington, DC 20010, USA.
TITLE	Persistent dizziness following head trauma and perilymphatic fistula.
SOURCE	Arch-Phys-Med-Rehabil 1995 Nov, VOL: 76 (11), P: 1017-20, ISSN: 0003-9993 26 Refs.
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 ear 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. Author.

3. AUTHOR	Grimm-R-J, Hemenway-W-G, Lebray-P-R, Black-F-O.
INSTITUTION	Department of Neurology, Good Samaritan Hospital and Medical Center, Portland, Oregon 97210.
TITLE	The perilymph fistula syndrome defined in mild head trauma.
SOURCE	Acta-Otolaryngol-Suppl (Stockh) 1989, VOL: 464, P: 1-40, ISSN: 0365-5237.
ABSTRACT	Neurological and neuro-otological studies were carried out on 102 adults with mild cranio-cervical trauma productive of positional vertigo and perilymph fistula as confirmed by laboratory tests, and by the finding of perilymph fistula at tympanotomy in the surgically managed group. In this patient group, all other neurological and neuro-otological diagnoses were excluded, e.g. epilepsy, cerebral palsy, multiple sclerosis, retardation; and for the neuro-otological group those with a history of ototoxicity, labyrinthitis, Meniere's disease, chronic ear infections, or developmental or familial disorders. Emphasis in this study was on mild trauma: fewer than half of the sample had been rendered unconscious in the injury of record, and a third of the cases were of whiplash type, with no loss of consciousness (LOC) and no remembered headstrike. These concomitant lesions comprise the perilymph fistula syndrome (PLFS) with a unique profile of neurological, perceptual, and cognitive deficits resembling a post-concussion injury. A complete description of the clinical picture is given, including psychological, cognitive and diagnostic tests, and the outcome of bedrest vs. surgical management. PLFS can arise from minor trauma, fistula are frequently bilateral (71/102), a mild sensorineural hearing loss is of variable occurrence (53%), secondary hydrops is not uncommon, and women appear more vulnerable than men for developing the syndrome. As based upon combined laboratory techniques and clinical symptomology, fistula were correctly predicted in 61 of 65 laser-operated ears. The positional vertigo component of PLFS was in all cases managed according to a special physical therapy program utilizing exercises for vestibular symptom habituation. Even when diagnosed late, a good- to-excellent outcome was achieved in 70% of treated patients. Author.

4. AUTHOR	Wall-C-3rd, Rauch-S-D.
INSTITUTION	Massachusetts Eye and Ear Infirmary, Boston 02114.
TITLE	Perilymph fistula pathophysiology.
SOURCE	Otolaryngol-Head-Neck-Surg 1995 Jan, VOL: 112 (1), P: 145-53, ISSN: 0194-5998 44 Refs.
ABSTRACT	A great deal of the controversy associated with perilymph fistula is due to the lack of a sensitive, specific way of detecting and thus diagnosing one. The existing subjective, clinical observations need to be replaced with an objective, scientific methodology having higher specificity and sensitivity for the detection of perilymph fistula. Three detection methods presently under development are presented here. One uses a miniendoscope to observe the middle ear. This procedure is less traumatic than inspection with tympanotomy. Thus it is less likely to create artifacts that can be mistaken for a fistula leakage. The "yes-no" observation decision is to be replaced with a graded quantitative measure. The second method concentrates on detected leakage from inner to middle ear. beta 2-Transferrin, a unique endogenous substance found in perilymph and cerebrospinal fluid, can be detected with one- or two-dimensional gel electrophoresis and immunoblotting. The third method is a system identification fistula test. It measures a change in a physiologic response that is caused by the presence of the fistula. Classic biophysical models of the vestibular end organs can be used to predict the dynamics of responses to systems identification stimuli. Author.