Urgent - perilymph fistula?

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Connecticut
I'm not a diver but the health problem I'm worried about is so esoteric that I feel like this is probably one of the best forums to post this on. If someone here is an ENT doctor who knows a lot about barotrauma, please read this. Also I'm a healthy 21-year-old male.

On June 5th I flew on a normal commercial plane with a pretty bad cold. Both of my nostrils were completely stuffed up at times. I stupidly didn't take any medications for it. When the plane was descending there were a few minutes where I felt pretty extreme ear pain and pressure in both ears. It felt like my ears were about to explode. It may have been the worst pain I've ever felt in my life, but maybe that's not saying much because I'm young and I've never broken a bone or anything. Anyway, while this was happening I was frantically googling ways to fix the problem, saw something about the valsalva maneuver, but I knew it was bad to blow really hard so I just did it gently but it didn't help. I was also blowing my nose to try to relieve the congestion but it didn't do much since my nostrils were so stuffed up anyway and I guess that was like an accidental valsalva too. I tried to yawn but couldn't really get a good one. After a few minutes the pain faded but my hearing was very muffled while this was happening. My ears popped a few times and each pop was pretty painful and jolting. My hearing was still pretty muffled for maybe an hour after getting off the plane. I wasn't dizzy at all.

On June 6th (the day after the plane) I went to an urgent care. The doctor told me my eardrums were "a little red" and that there was some fluid in the part of the ear that's right behind the eardrum. I was also told that there was some bulging. At this point my hearing was still a little bit muffled, but only when hearing my own voice which sounded a bit different than normal. Otherwise my hearing seemed normal.

On June 8th (3 days after the plane) I started to notice a bit of positional dizziness, some feeling of being off balanced, motion sick, and a little bit "off", if that makes sense. But no actual vertigo; it never felt like the world was spinning. Also my ears were still popping and crackling.

On June 10th (5 days after the plane) I saw an ENT doctor. Audiogram was normal; no sensorineural hearing loss. But I didn't do any vestibular testing. The doctor looked at my ears with a microscope and told me there was no fluid and the eardrums looked good. I told him about the dizziness and he said that's due to eustachian tube dysfunction which can take a few weeks to go away. I told him I was worried about a perilymph fistula and he immediately dismissed the concern, telling me he's 99.9% sure that I don't have one.

It's now June 15th, 10 days after the plane. I still have all the same symptoms that I started noticing on June 8th. For example, when I'm having a conversation with someone and nodding my head or shaking it to nonverbally say yes or no, I get dizzy just from that. My head also feels heavy when I lift it after having it resting on a headrest. I also feel some pressure in my ears that comes on once in a while, in both ears at once. They are often cracking and popping when I yawn. I also feel a little dizzy when turning when I walk. I'm not falling over or anything, but I feel a tiny bit off balanced too. One way that I can describe how I feel is that it's sort of like I constantly feel like I got off of an amusement park ride a few minutes ago (but maybe that's a bit of an exaggeration). I feel better when I'm lying down.

Anyway, I'm really worried that I have an undiagnosed perilymph fistula which would be causing me to gradually lose my hearing (haven't noticed any hearing loss yet). I'm a hypochondriac with severe OCD so I'm really not sure if me worrying about this is just my OCD or if this is real. I'm constantly googling stuff about perilymph fistulas. What should I do? Find another ENT? I'm in Connecticut. Should I wait a few weeks to see if my symptoms go away? I'm worried that if I just wait around, my hearing will get progressively worse. Is it plausible for the ENT doctor to be correct that my symptoms are just due to eustachian tube dysfunction? I should also note that my nostrils are now completely clear. Also, I've never had ear problems before. My ears felt completely fine before the plane.
 
I'm not a diver but the health problem I'm worried about is so esoteric that I feel like this is probably one of the best forums to post this on. If someone here is an ENT doctor who knows a lot about barotrauma, please read this. Also I'm a healthy 21-year-old male.

On June 5th I flew on a normal commercial plane with a pretty bad cold. Both of my nostrils were completely stuffed up at times. I stupidly didn't take any medications for it. When the plane was descending there were a few minutes where I felt pretty extreme ear pain and pressure in both ears. It felt like my ears were about to explode. It may have been the worst pain I've ever felt in my life, but maybe that's not saying much because I'm young and I've never broken a bone or anything. Anyway, while this was happening I was frantically googling ways to fix the problem, saw something about the valsalva maneuver, but I knew it was bad to blow really hard so I just did it gently but it didn't help. I was also blowing my nose to try to relieve the congestion but it didn't do much since my nostrils were so stuffed up anyway and I guess that was like an accidental valsalva too. I tried to yawn but couldn't really get a good one. After a few minutes the pain faded but my hearing was very muffled while this was happening. My ears popped a few times and each pop was pretty painful and jolting. My hearing was still pretty muffled for maybe an hour after getting off the plane. I wasn't dizzy at all.

On June 6th (the day after the plane) I went to an urgent care. The doctor told me my eardrums were "a little red" and that there was some fluid in the part of the ear that's right behind the eardrum. I was also told that there was some bulging. At this point my hearing was still a little bit muffled, but only when hearing my own voice which sounded a bit different than normal. Otherwise my hearing seemed normal.

On June 8th (3 days after the plane) I started to notice a bit of positional dizziness, some feeling of being off balanced, motion sick, and a little bit "off", if that makes sense. But no actual vertigo; it never felt like the world was spinning. Also my ears were still popping and crackling.

On June 10th (5 days after the plane) I saw an ENT doctor. Audiogram was normal; no sensorineural hearing loss. But I didn't do any vestibular testing. The doctor looked at my ears with a microscope and told me there was no fluid and the eardrums looked good. I told him about the dizziness and he said that's due to eustachian tube dysfunction which can take a few weeks to go away. I told him I was worried about a perilymph fistula and he immediately dismissed the concern, telling me he's 99.9% sure that I don't have one.

It's now June 15th, 10 days after the plane. I still have all the same symptoms that I started noticing on June 8th. For example, when I'm having a conversation with someone and nodding my head or shaking it to nonverbally say yes or no, I get dizzy just from that. My head also feels heavy when I lift it after having it resting on a headrest. I also feel some pressure in my ears that comes on once in a while, in both ears at once. They are often cracking and popping when I yawn. I also feel a little dizzy when turning when I walk. I'm not falling over or anything, but I feel a tiny bit off balanced too. One way that I can describe how I feel is that it's sort of like I constantly feel like I got off of an amusement park ride a few minutes ago (but maybe that's a bit of an exaggeration). I feel better when I'm lying down.

Anyway, I'm really worried that I have an undiagnosed perilymph fistula which would be causing me to gradually lose my hearing (haven't noticed any hearing loss yet). I'm a hypochondriac with severe OCD so I'm really not sure if me worrying about this is just my OCD or if this is real. I'm constantly googling stuff about perilymph fistulas. What should I do? Find another ENT? I'm in Connecticut. Should I wait a few weeks to see if my symptoms go away? I'm worried that if I just wait around, my hearing will get progressively worse. Is it plausible for the ENT doctor to be correct that my symptoms are just due to eustachian tube dysfunction? Also, I've never had ear problems before. My ears felt completely fine before the plane.
@doctormike can you help me?
 
I will defer to DDM or doctormike for the specifics as I am not an ENT.

But some basic etiology. Rate of perilymphatic fistula is around 1.5/100,000, so fairly rare.

Additionally “Commonly, patients present with both audiologic and vestibular symptoms, though they can be variable, and aural fullness in particular may be sensitive for PLF.”

Initially treatment for other causes of vertigo and ear symptoms is performed before entertaining PLF

“Clinicians should maintain high suspicion for a PLF when individuals with non-specific audiovestibular symptoms do not respond to conventional medical treatments or vestibular rehabilitation and when there is a history of onset after trauma or an inciting event”


I too recall flying with a head cold when I was 16 or so. No problem going to elevation, but miserable pain coming down. If someone would have given me an ice pick I would have jammed it into my ears. At the time, longest 15-20 minutes of my life (now replaced with a dental extraction that the nerve block failed). Fortunately my ears finally popped and I don’t recall any persistent symptoms there after, but it’s admittedly been decades.

It’s easy to go down a rabbit hole on google. Eventually everything says you have cancer and are going to die. A good evaluation by an ENT is reassuring. I’d continue with treatment for ETD and give things a chance to get better. As noted that can take weeks.
 
I'm not a diver but the health problem I'm worried about is so esoteric that I feel like this is probably one of the best forums to post this on. If someone here is an ENT doctor who knows a lot about barotrauma, please read this. Also I'm a healthy 21-year-old male.

On June 5th I flew on a normal commercial plane with a pretty bad cold. Both of my nostrils were completely stuffed up at times. I stupidly didn't take any medications for it. When the plane was descending there were a few minutes where I felt pretty extreme ear pain and pressure in both ears. It felt like my ears were about to explode. It may have been the worst pain I've ever felt in my life, but maybe that's not saying much because I'm young and I've never broken a bone or anything. Anyway, while this was happening I was frantically googling ways to fix the problem, saw something about the valsalva maneuver, but I knew it was bad to blow really hard so I just did it gently but it didn't help. I was also blowing my nose to try to relieve the congestion but it didn't do much since my nostrils were so stuffed up anyway and I guess that was like an accidental valsalva too. I tried to yawn but couldn't really get a good one. After a few minutes the pain faded but my hearing was very muffled while this was happening. My ears popped a few times and each pop was pretty painful and jolting. My hearing was still pretty muffled for maybe an hour after getting off the plane. I wasn't dizzy at all.

On June 6th (the day after the plane) I went to an urgent care. The doctor told me my eardrums were "a little red" and that there was some fluid in the part of the ear that's right behind the eardrum. I was also told that there was some bulging. At this point my hearing was still a little bit muffled, but only when hearing my own voice which sounded a bit different than normal. Otherwise my hearing seemed normal.

On June 8th (3 days after the plane) I started to notice a bit of positional dizziness, some feeling of being off balanced, motion sick, and a little bit "off", if that makes sense. But no actual vertigo; it never felt like the world was spinning. Also my ears were still popping and crackling.

On June 10th (5 days after the plane) I saw an ENT doctor. Audiogram was normal; no sensorineural hearing loss. But I didn't do any vestibular testing. The doctor looked at my ears with a microscope and told me there was no fluid and the eardrums looked good. I told him about the dizziness and he said that's due to eustachian tube dysfunction which can take a few weeks to go away. I told him I was worried about a perilymph fistula and he immediately dismissed the concern, telling me he's 99.9% sure that I don't have one.

It's now June 15th, 10 days after the plane. I still have all the same symptoms that I started noticing on June 8th. For example, when I'm having a conversation with someone and nodding my head or shaking it to nonverbally say yes or no, I get dizzy just from that. My head also feels heavy when I lift it after having it resting on a headrest. I also feel some pressure in my ears that comes on once in a while, in both ears at once. They are often cracking and popping when I yawn. I also feel a little dizzy when turning when I walk. I'm not falling over or anything, but I feel a tiny bit off balanced too. One way that I can describe how I feel is that it's sort of like I constantly feel like I got off of an amusement park ride a few minutes ago (but maybe that's a bit of an exaggeration). I feel better when I'm lying down.

Anyway, I'm really worried that I have an undiagnosed perilymph fistula which would be causing me to gradually lose my hearing (haven't noticed any hearing loss yet). I'm a hypochondriac with severe OCD so I'm really not sure if me worrying about this is just my OCD or if this is real. I'm constantly googling stuff about perilymph fistulas. What should I do? Find another ENT? I'm in Connecticut. Should I wait a few weeks to see if my symptoms go away? I'm worried that if I just wait around, my hearing will get progressively worse. Is it plausible for the ENT doctor to be correct that my symptoms are just due to eustachian tube dysfunction? I should also note that my nostrils are now completely clear. Also, I've never had ear problems before. My ears felt completely fine before the plane.
Hi @Spencer123 , I would defer to your ENT's assessment. Though your symptoms are consistent with some sort of inner ear involvement, the symptoms of perilymph fistula tend to be more severe. Patients most often present with some combination of hearing loss, severe vertigo and tinnitus. It is possible to have a non-fistulating inner ear barotrauma. If that's what you have, then your symptoms should improve over time. Inflammation of the middle and inner ear area can take weeks to resovle, so I would gauge your improvement from that perspective. Of course if you're not satisfied with this answer or your ENT's assessment you can always go to a different ENT for another opinion.

Best regards,
DDM
 
Hard to say much over the Internet, but commonly if you have a PLF there is a hearing loss as well. It would be unusual to get a PLF without a congenital bony abnormality of the ear just from flying, although I suppose there is a bell curve for everything! But that's more of a diving issue, where the pressure changes are greater. Usually, the diagnosis of PLF is made at surgery, it's not something you can see on a scan.

If you want a second opinion, you should see an otologist (ear specialist) if you haven't already. I can give you some good names if you are near NYC and are willing to come into town.
 
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