title: Perilymph fistula--45 case analysis.
abstract: OBJECTIVE
  Though perilymph fistula (PLF) is not a rare disease, preoperative diagnosis still remains to be established. Some new diagnostic methods are challenging, but there is still no established diagnostic method except exploratory tympanotomy that verifies the occurrence of leakage. Early diagnosis of PLF is fully depending on history taking and some clinical examinations. To know the clinical features of PLF is one of the greatest helps to make both earlier and accurate diagnosis. In spite of some innovations in clinical examinations classic diagnostic procedure is thought to be still reliable.
  
  
  METHODS
  We investigated the clinical symptoms, basic tests results and therapeutic results in patients with PLF.
  
  
  RESULTS
  From 1983 to 1998 PLF was identified in 44 patients (45 ears) with exploratory tympanotomies in our hospital. With respect to clinical history the predisposing factors such as blowing the nose, lifting heavy goods, and landing in an airplane were found in almost half of the patients, while the rest of them had no clear inducing factors. Their major symptoms included hearing loss (93%), vertigo and dizziness (91%), tinnitus (76%), and aural fullness (31%). The patients who have a clear predisposing factor tended to make diagnosis easily; on the other hand the rest of the patients who do not have clear etiology had some diagnostic difficulty. Subjective positive fistula signs were observed in 71% of patients. Vestibular symptoms improved in 80% of patients after closure of PLF.
  
  
  CONCLUSIONS
  These results suggest that the variety of clinical manifestation make diagnosis more difficult. At the moment meticulous clinical history taking and close follow-up applying repeating fistula tests are the most important for not only earlier but also accurate diagnosis.
authors.affiliation: Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan. f.goto@irz.uni-muenchen.de
authors.forename: F
authors.initials: F
authors.lastname: Goto
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Kunihiro
authors.forename: K
authors.initials: K
authors.lastname: Kurashima
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: J
authors.initials: J
authors.lastname: Kanzaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005402:Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007759:Labyrinth Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009760:Nystagmus, Physiologic / Q000502:physiology; D010498:Perilymph; D014012:Tinnitus / Q000175:diagnosis / Q000209:etiology; D014433:Tympanoplasty; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology