PERSISTENT DIZZINESS FOLLOWING HEAD TRAUMA AND PERILYMPHATIC FISTULA

A growing body of evidence supports the idea that dizziness that persi sts for months and even years can be caused by an unsuspected perilymp hatic fistula. Perilymphatic fistulas are abnormal ruptures that allow perilymph to leak out of the inner ear into the middle ear space. Mos t commonly, these ruptures occur secondary to a traumatic event. The t erm postconcussive syndrome has been used to describe a myriad of symp toms following head trauma. Some of these symptoms, such as cognitive changes, tinnitus, neck stiffness, and dizziness, are also commonly ca used by active perilymphatic fistulas. This article discusses the typi cal history and diagnostic tests for patients with perilymphatic fistu la. Common diagnostic tests include audiograms, electronystagmograms, electrocochleograms, and subjective and platform fistula tests. Also, the surgical treatment for the perilymphatic fistula (ie, repair of th e oval and round windows) is reviewed, along with the results produced by this relatively minor ear operation. Suggestions are made to help the medical professionals involved in rehabilitative care to be aware of perilymphatic fistulas and seek proper consultations from inner ear specialists if they suspect the existence of this easily cured disord er. (C) 1995 by the American Congress of Rehabilitation Medicine and t he American Academy of Physical Medicine and Rehabilitation.