Perilymph Fistulae: An Uncommon Cause of Dizziness

Dizziness is common complaints that people seek medical attention for. It is listed as one of the top ten symptoms evaluated by primary care providers. To determine the cause of dizziness requires a detailed and careful history and physical examination, with a particular focus on the otolaryngological aspects. A differential diagnosis can be generated from the initial evaluation that can be further corroborated with laboratory tests and imaging studies such as audiograms, video nystagmography, CT scans and MRIs. At this stage, one can often determine whether a patient presents with a vestibular or non-vestibular cause and then refer to the appropriate specialist. To an otolaryngologist, a vestibulopathy is usually apparent in the initial encounter and can be categorized as benign positional vertigo, vestibular neuronitis, viral labyrinthitis, or Meniere’s disease. However, when the patient does not conform to these categories, one must consider other causes, such as atypical or vestibular migraine, superior canal dehiscence syndrome, débarquement syndrome, or perilymph fistula (PLF).