A case report of bilateral perilymph fistula in an adult, with literature review

Abstract

Adult bilateral perilymph fistula (PLF) is rare. We report a case of a 55-year-old man who suffered from sudden bilateral hearing loss after blowing his nose. On the first day, he also had bilateral tinnitus but no vertigo. However, he gradually developed vertigo, and nystagmus to the left side began to appear in the following days. Exploratory bilateral tympanotomies were performed and perilymph fistulas were observed at the round window niche in both ears. The round windows were obliterated with fascia of the temporal muscles. After the operation no changes were found in both sides on a pure tone audiogram even at a one-year follow-up. The literature was reviewed and several features were statistically analyzed. In the adult bilateral PLF group, the proportion of the cases in which the cause of PLF was clear was significantly higher than that in the adult unilateral PLF group, but the other clinical features were almost the same. The results suggest that in adults the occurrence of bilateral and unilateral PLF could depend on the level of pressure applied to the middle or inner ear. On the other hand, in the child PLF group, the ratio of bilateral involvement was considerably higher than that in the adult PLF group, and in most cases the PLF was associated with middle and/or inner ear malformations. Healing in the child bilateral PLF group was poor than that in the adult PLF group. Those results suggest that the etiology of bilateral PLF in children may be considerably different from that of adult PLF.