I had a fistula repaired mid December, Prior to surgery I had the severe
spinning and
occasional vomiting for three weeks. Surgery went well, but I still feel
whirling motions almost all the time especially while walking and driving. I
have severe ringing
that is almost constant. It seems as if the whirling sensation is worse when
the ringing is at its loudest. Do you think these two things are related. I
still lose my balance. This has improved greatly from the time befor surgery
but I still feel dizzy
very often through out the day. Do you think I will regain my sence of
balance in full. Had CT scan prior to surgery. MRI after surgery which was
normal. I feel that when I walk and Drive my eye balls are bouncing up & down
in my head. I saw an eye specialist and he assured me that was not the case.
When my ear is ringing and the pitch is extremely high I also have piercing
pain that turns to a dull ache that doesnt seem to last but a few minutes.
The ringing may last for as long as 20 minutes at a time.The Doctor says its
still healing in here. This was a fistula caused by strain.
I'm only in my early 30's as my hearing loss is permanent. I was told not
even a hearing aid will help. The hairs inside the middle ear were starved of
fluid which made them die. Please respond and let me know what you think.
P.S. I've found that bright lights, the sun also seems to bring on the
ringing. Thankyou
Reply: ---------------------
A recent comprehensive review of idiopathic perilymphatic fistulas was published in The Otolaryngologic Clinics of North America in April 1996 entitled "Update on Idiopathic Perilymphatic Fistulas". The following are considered the diagnostic criteria for such fistulas: sudden loss of hearing or rapidly progressive decline in hearing combined with positional vertigo, constant dysequilibrium, or a positive "fistula test" (a test in which positive and negative pressure are applied to the ear drum in an attempt to provoke the symptom of dizziness). This condition is associated with a leakage of fluid from within the inner ear into the middle ear space through an acquired or congenital communication.
The treatment of such fistulas has been somewhat controversial. It is clear that non-surgical therapy is effective in some patients. Non-surgical therapy includes maintenance of a head elevation (30 degrees) when in bed, avoidance of heavy lifting (nothing > 10 lbs.) and some advocate a trial of prednisone. Conservative measures with or without prednisone should be tried initially for up to 6 weeks. If symptoms fail to improve then surgical exploration is generally recommended.
Surgical therapy involves exploring the middle ear to attempt to identify the source of the suspected leak which is usually around the stapes bone or the round window membrane. The leak once found is closed with a graft of tissue to seal it.
An estimated 30 -40% of patients who meet the criteria for a diagnosis of idiopathic perilymphatic fistula will improve with non-surgical therapy. For those who require surgery, a reported 90% or above will improve. Many will have some post-operative brief episodes of milder dysequilibrium which lasts for a variable period of time.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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