PLF (PERILYMPH FISTULA)–MAY REALLY BE SSCD
REALLY AN ENIGMA—-A DIAGNOSIS OF EXCLUSION—CAN BE TRAUMATIC (POST OP STAPES SUBLUXATION), SPONTANEOUS, INFLAMMATORY (CHOLESTEATOMA ON THE LAT SCC) OR NEOPLASTIC
CREATES A RELATIVE HYDROPS BY DRAINING OUT THE PERILYMPH—GIVES HYDROPIC SYMPTOMS AND SIGNS!
USUALLY PRESENTS AS A TRIAD OF VERTIGO, HL, AND BROAD BAND TINNITUS
OFTEN —-DYSEQUILIBRIUM, MOTION INTOLERANCE (SUPERMARKET SYNDROME), POSITIONING VERTIGO—HALLPIKE WITH SICK EAR DOWN—USUALLY HORIZONTAL AND GEOTROPHIC, AURAL FULLNESS (25%), SUDDEN (OFTEN HEARS A POP ASSOC WITH STRAINING) AND INCOMPLETE AND FLUCTUATING SNHL WITH FLUCTUATING DISCRIMINATION AND POSSIBLE TULLIOS PHENOM, POSSIBLE EYES CLOSED TURNING TEST AS WELL
QUIX TEST—–LIKE A RHOMBERG—ARMS DRIFT TO THE SIDE OF THE LESION
(VERTIGO WITH NOISE), POSITIVE FISTULA TEST (80%) OR AT LEAST HENNEBERT’S SIGN—SHOULD ALSO GET SOME REVERSAL OF THESE TESTS WITH A GLYCEROL CHALLENGE
HENNEBERT (1911)—CONTRALATERAL DEVIATION OF THE EYES WITH POS PRESSURE FOR 1-2 SECONDS—THOUGHT TO BE DUE TO JUXTAPOSITION OF THE STAPES AND UTRICLE—–DIFFERENT THAN NYLEN’S (1923) PERLYMPH FISTULA TEST—NYSTAGMUS IN THE PLANE OF THE AFFECTED SCC SUSTAINED FOR GREATER THAN 10 SECONDS WITH POSITIVE PRESSURE
CAN GET A FALSE POSITIVE WITH EITHER OF THESE 2 TESTS 30% OF THE TIME IN BOTH MENEIR’S AND OTOSYPHILIS
MORE COMMON IN THE L THAN THE RIGHT (LARGER COCHLEAR AQUEDUCT ON THE LEFT)
FISSULA ANTE FENESTRUM OF OVAL WINDOW IS MOST COMMON > RW > HYRTL’S FISSURE
THINK OF CHOLESTEATOMA, MONDINI DEFORMITY, RECENT TRAUMA (BAROTRAUMA)
Dx EXCLUSION—–HISTORY, SERIAL AUDIOGRAMS, MHATP, CT SCAN (IMAGING MODALITY OF CHOICE, MRI, ESR, ENG FISTULA TEST, GAIT, CORNEAL TEST, BARANY BOX—TULLIOS PHENOM
CAN SOMETIMES SEE THE BONEY DEHISSENCE ON CT AS WELL AS PNUEMOLABYRINTH
Rx—PROBABLY CONSERVATIVE—BEDREST ECT… IF NOT TRAUMATIC—OTHERWISE CAN DO MEE—IF YOU ARE IN THERE—PATCH THINGS ANYWAY
THIS ENTITY PROBABLY EXISTS BUT THERE IS CERTAINLY A LOT OF OVERLAP WITH SEVER HYDROPS WHICH JUST RESPONDS TO THE GENERAL ANESTHETIC AND TINCTURE OF TIME