A case of perilymph fistula with hearing improvement in the supine position

Abstract

The diagnosis of perilymph fistula (PLF) is sometimes difficult. We herein report a case of perilymph fistula with hearing improvement in the supine position. The patient was a 54-year-old woman who noticed right hearing loss after a popping sound in her right ear in an airplane 1 year previously. Two weeks before her first visit, she developed vertigo. At the first visit, the pure tone averages of her right and left ears were 30.0 dB and 15.0 dB, respectively, and she had continuous right-sided nystagmus, regardless of her head position. Positive and negative PLF tests were subtle in the right ear. Additionally, the pure tone averages of the right ear showed improvement from 31.7 dB in the sitting position to 15.0 dB in the supine position, which led us to conclude that the patient had a right PLF. Because her vertigo persisted despite hospitalization and bed rest, surgery was performed and perilymph leakage was detected at the round window. Her vertigo was cured after the repair of the PLF. A comparison of the pure tone averages in the sitting and supine positions might be a useful method for detecting PLF and can be performed in any otolaryngology clinic or hospital.