AbstractBetween July 1976 and August 1979, 14 patients underwent surgical repair of a traumatic tympanic membrane perforation. Of these 14 patients, 9 were found to have a profuse perilymph fistula of the round and/or oval window. The perilymph fistula involved the oval window in 2 patients, the round window in 2 patients, and both the oval and round windows in 5 patients. The paucity of suggestive symptoms was the rule, rather than the exception. The mean sensorineural component of hearing loss in the 9 patients was only 11 db, and was often so slight as to be overlooked preoperatively. Only 1 of the 9 patients had vertigo. Six of the 9 had no unsteadiness. Of the 9 patients, 6 had intermittent or no tinnitus; 6 of the 9 paaients had a history of bloody otorrhea; and at their initial examination, 6 of the 9 patients had a dry tympanic membrane perforation. The fistula test was positive in 4 of the 5 patients tested. Of the 8 patients tested, 6 had a positive tandem Romberg sign. The fistulas were repaired with a tissue graft and all had their sensorineural hearing loss return to normal.There was very little difference between the hearing, complaints of tinnitus, unsteadiness, and vertigo in patients with traumatic tympanic membrane perforations with profuse perilymph fistulas and those without fistulas. This fact, coupled with the high incidence (64%) of associated perilymph fistulas, leads the authors to suggest early repair of traumatic tympanic membrane perforations with careful examination of both the round and oval windows. Perilymph fistulas should be suspected in patients with a positive fistula test and/or a positive tandem Romberg sign.