Intratympanic injection of autologous blood for traumatic perilymphatic fistulas.

Aperilymphatic fistula (PLF) is any abnormal communication between the middle ear or mastoid and the inner ear. Trauma, prior stapes surgery, and barotrauma are accepted etiologies; however, controversy exists over the existence of spontaneous PLF. Typical symptoms include fluctuating sensorineural hearing loss, tinnitus, aural fullness, vertigo, and disequilibrium. PLF diagnosis is based on history, complete examination, and a positive fistula test. A positive fistula test is confirmed by the elicitation of nystagmus or a sense of motion. Treatment options include conservative management or surgical treatment depending on the severity and duration of the symptoms. Medical management includes bed rest, head elevation, stool softeners, and avoidance of straining, coughing, or sneezing. Surgical management consists of exploratory tympanotomy and grafting of the oval and round windows. This paper retrospectively analyzes three cases of a novel approach to treatment of traumatic PLFs when medical management had failed.