Key Points about Surgical Repair for Perilymph Fistula (Tympanoplasty)

  • Surgical repair for the perilymph fistula, also known as tympanoplasty, is a procedure to reconstruct your eardrum.
  • Surgery to repair a perilymph fistula is appropriate for patients who have failed in finding relief from nonsurgical treatment and have severe symptoms.
  • Risks associated with surgery to repair perilymph fistula include perforated eardrum, ear infection, progressive hearing loss, facial nerve injury, loss of sense of taste on the affected side, and persistent dizziness or ringing in the ear.
  • During recovery, you should avoid any strenuous activity, straining, or lifting heavy objects. You should also sleep with your head elevated. After two weeks, you can resume your normal activity level.
  • While the procedure is not invasive, recovery is lengthy.


Patients who have progressive hearing loss associated with benign paroxysmal positional vertigo (BPPV) may require surgery to repair the perilymph fistula.

A perilymph fistula, also called a PLF, is an unusual opening between the middle ear and the fluid-filled inner ear.

During the surgery, your doctor will lift the eardrum through the ear canal and place a graft in the hole.

The goal of surgery is to stabilize the ear when you move your head.

Candidates for a surgical repair for perilymph fistula

Strict bed rest is the first-line therapy to treat perilymph fistula. If your symptoms are severe and not improved with two weeks of bed rest, surgery may be an option.

Risks associated with a surgical repair for perilymph fistula

Complications associated with surgical repair of perilymph fistula include:

  • Perforated eardrum
  • Ear infection
  • Increased hearing loss
  • Paralysis associated with a facial nerve injury
  • Loss of sense of taste on the affected side
  • Constant dizziness or ringing in the ear

Preparing for a surgical repair for perilymph fistula

In preparation for surgery, your doctor will outline specific guidelines to follow to ensure a successful surgery. Guidelines may include:

  • Avoid all strenuous activities or lifting before surgery
  • Arrange to have someone drive you home after surgery
  • Inform your doctor of all medications you are taking and stop taking any medications that may interfere with the surgery or recovery
  • Stop smoking
  • Prepare for being on bed rest during recovery

Expectations during a surgical repair for perilymph fistula

Surgery is an option for patients who have not found relief with non-surgical treatments such as bed rest and a blood patch.

Surgery is performed under general anesthesia, so you will go home after you have recovered.

During surgery, your doctor will make an incision behind the ear. He or she will lift the eardrum and place a fascia graft in the hole. The graft is made from your cartilage and is held in place with packing that is placed in the middle ear.

The procedure takes approximately 30 minutes to two hours to perform. It is performed in an outpatient setting, so you will be able to go home the day of surgery.

Recovery from surgical repair for perilymph fistula

During recovery, you will be instructed to avoid strenuous activity, to strain, and to lift objects over 20 pounds. You will also need to sleep with the head of your bed elevated for two weeks.

After two weeks, you can resume your normal activities. While most patients will not recover their hearing, the feeling of dizziness will subside.

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