Perilymphatic fistula--a definitive and curable cause of vertigo following head trauma.

Vertigo or disequilibrium occurring in patients after concussive and nonconcussive head trauma may be due to a pathologic perilymphatic fistula from the inner ear through the oval and round window areas of the middle ear. Of 33 patients who had successful grafting of the fistulous area at middle ear exploration, 32 had resolution of vertigo, and 12 of 23 who had an associated hearing loss had improved hearing. Perilymphatic fistulas associated with vertigo and hearing loss after head trauma can be diagnosed with great certainty and are surgically curable in the great majority of cases. Patients with post-concussive syndrome, whose symptoms include vertigo or disequilibrium, should have a thorough otologic evaluation for the possibility of a perilymphatic fistula.