Diving, whether it’s competitive or something you do occasionally, can place added pressure on sensitive parts of your inner ear. This extra pressure may affect your balance and result in problems in the inner or middle ear area. Divers, in particular, are more susceptible to developing a condition within this part of the ear referred to as a perilymphatic fistula (PLF).
What is a Perilymphatic Fistula?
Perilymphatic fistula is an abnormal opening in oval and round windows near the temporal bone that houses the inner and middle portion of the ear. Normally covered by thin, protective membranes, these windows control hearing and balance by transmitting sound from the inner ear to the middle part of the ear. A tear in these membranes may be caused by:
- Ear pressure from diving
- Pressure changes on an airplane
- Strain from heavy lifting
Which Signs Should You Look For?
Fluid flows between the inner and middle ear when there’s an opening in the oval and round windows in this space. The free-flowing fluid may throw off your balance or make you feel dizzy or lightheaded. These feelings may worsen if you’re diving with this fluid traveling around in one or both ears, or when participating in any activity that involves bending or moving your body in a way where pressure in your ear is likely to shift. Related PLF symptoms may include:
- Persistent ear ringing (tinnitus)
- Sensations of spinning (vertigo)
- Motion intolerance
How Are Perilymphatic Fistulas Diagnosed?
You’ll likely be referred to an ear, nose and throat specialist if you have a suspected perilymphatic fistula. Confirming a diagnosis involves a thorough exam and consideration of a patient’s history with ear problems. Hearing assessments such as a fistula test or audiogram are usually performed. A CT scan may be performed to rule out possible conditions that may cause similar symptoms.
What Are Your Treatment Options?
Initial treatment for a perilymphatic fistula is conservative (non-surgical). Bed rest should be limited to avoid further issues with balance and hearing from the fluid shift that occurs when in a resting position. A newer technique involves creating a blood patch by injecting blood into the affected part of the middle ear to seal the opening. It’s usually recommended for patients who’ve had other fistulas or symptoms indicating previous fistulas.
When is Surgery Considered?
A blood patch injection may be repeated if symptoms aren’t going away after the first one. If two injections fail to provide relief, surgery may be recommended. During the procedure, the eardrum (tympanic membrane) is lifted through the ear canal. Doing so covers the affected windows and covers the opening.
If surgery is necessary for a perilymphatic fistula, recovery usually takes a few weeks. During this time, you’ll need to avoid any activities that are excessively strenuous and not lift anything heavier than 20 pounds. Keep your head elevated as you sleep and follow any instructions provided by your surgeon. If your goal is to return to diving, wait until all signs of dizziness or balance issues are gone.