Key Points about Perilymph Fistula (PLF)

  • PLF is most often caused by a head injury, but can also be caused by an ear injury, object perforating the eardrum or rapid increases in intracranial (inside the skull) pressure.
  • There is no test for to diagnose PLF, so your ENT doctor will ask you questions about your symptoms and perform a hearing test and balance test.
  • In many cases, symptoms of PLF will resolve on their own after a week or two.


Perilymph fistula (PLF) is a small membrane tear between the middle and inner ear that causes inner ear fluid to leak into the middle ear. People with PLF often feel pain during changes in air pressure, intense activity, sneezing, coughing or nose-blowing. Because PLF symptoms are often confused with Meniere’s disease, it is very important to see a doctor if you experience any symptoms.

Perilymph fistula causes

The most common cause of PLF is head trauma, such as a “whiplash” accident. Other possible causes include:

  • Ear trauma
  • Objects perforating the eardrum
  • Ear block caused by descent on an airplane or during SCUBA diving
  • Rapid increase in intracranial pressure, such as during extreme weightlifting or childbirth

Perilymph fistula risk factors

The main risk factor for developing PLF is having suffered a severe head injury.

PLF symptoms

The signs and symptoms of PLF may include:

  • Difficulty tolerating fast or spinning motions
  • Dizziness
  • Feeling of pressure in the ear, or full feeling in the ear
  • Highly sensitive hearing

These symptoms typically worsen during altitude changes or during heavy lifting, bending over, coughing or sneezing.

Perilymph fistula diagnosis

Though there is no one definitive test for PLF, your ENT doctor may use one or more of the following diagnostic tools to diagnose the condition:

  • Physical examination — Your ENT doctor will perform a complete physical exam, and ask you questions about your health history in general and your PLF symptoms specifically.
  • Hearing test — A hearing test can evaluate the sensitivity of your hearing.
  • Balance exam — This test checks your balance and inner ear function.

Perilymph fistula treatment

Your ENT doctor may use one or more of the following treatments to help manage your Perilymph fistula:

  • If a traumatic injury causes your PLF, your specialist may recommend you rest for 7 to 14 days, to see if your symptoms decrease over time.
  • If rest and watchful waiting are not enough to ease your PLF, your ENT doctor may recommend a surgical procedure to correct the underlying cause.

When to seek care

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an ENT doctor for more specialized treatment.

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