title: Perilymphatic fistula after underwater diving: a series of 11 cases.
abstract: BACKGROUND
  Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula.
  
  
  METHODS
  We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment.
  
  
  RESULTS
  Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12).
  
  
  CONCLUSIONS
  The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early.
authors.affiliation: Ear, Nose and Throat, and Cervicofacial Surgery, Institut de Recherche Biomédicale des Armées Hôpital d'Instruction des Armées Sainte Anne, BP 600 - 83800, Toulon Cedex 9, France, jbmorvan@hotmail.com.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Morvan
authors.affiliation: Hyperbaric Medicine and Diving.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gempp
authors.affiliation: Ear, Nose and Throat, and Cervicofacial Surgery.
authors.forename: Damien
authors.initials: D
authors.lastname: Rivière
authors.affiliation: Hyperbaric Medicine and Diving.
authors.forename: Pierre
authors.initials: P
authors.lastname: Louge
authors.affiliation: Hyperbaric Medicine and Diving.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vallee
authors.affiliation: Ear, Nose and Throat, and Cervicofacial Surgery.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verdalle
mesh_terms: D000328:Adult; D000368:Aged; D001469:Barotrauma / Q000150:complications*; D003052:Cochlear Aqueduct / Q000293:injuries*; D015834:Cochlear Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D003638:Deafness / Q000209:etiology; D004242:Diving / Q000293:injuries*; D004244:Dizziness / Q000209:etiology; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014012:Tinnitus / Q000209:etiology; D055815:Young Adult
keywords: ENT; Inner ear; breath-hold diving; ear barotrauma; outcome; scuba diving; surgery