Images in Clinical Medicine
Perilymph Fistula Test
N Engl J Med 2012; 366:e8January 26, 2012
- Article
Video
Perilymph Fistula Test.
A 42-year-man presented with severe nausea and vertigo, which were precipitated by the application of pressure just anterior to the left external auditory canal. Otoscopic examination revealed a cholesteatoma arising from the pars flaccida of the left tympanic membrane. When pressure was applied to the left tragus, horizontal nystagmus developed in the patient's left eye (see video). The development of nystagmus in response to the application of pressure on the external auditory canal constitutes a positive result for the perilymph fistula test and suggests the presence of a fistula between the air-filled middle ear and the fluid-filled inner ear. In this case, left-beating horizontal nystagmus suggested the presence of a bony fistula extending from the middle ear to the left lateral semicircular canal. Computed tomographic imaging of the temporal bone revealed a lesion with the density of soft tissue, probably a cholesteatoma, filling the middle ear and mastoid cavity. The osseous portion of the lateral semicircular canal was eroded (arrow). During surgical exploration, the membranous portion of the lateral semicircular canal was found to be intact, and no perilymph leakage was observed. The cholesteatoma was surgically removed, and the fistula site was repaired. From the time of surgery until his last follow-up visit 18 months later, the patient reported no dizziness.
Hosuk Chu, M.D.
Won-Ho Chung, M.D.
Sungkyunkwan University, Seoul, South Korea
