The causation of perilymph fistulae in divers.

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Title: The causation of perilymph fistulae in divers.
Author: Donoghue, P; Knight, J
Abstract: On 23 December 1979 a 23 year old man went swimming in a lake. He had no snorkel or SCUBA equipment. He duck-dived to the bottom of the lake (10 feet - 3 metres). He stayed on the bottom by holding on to a rock. Suddenly he noticed a low pitched tinnitus in his left ear. He was not trying to Valsalva at the time. When he left the water the tinnitus disappeared. Soon after this he had attacks of left sided tinnitus whenever he stooped down or turned his head to the right. On 28 December 1979 he developed, in addition, attacks of vertigo lasting a few minutes whenever he stooped down. At no stage did he notice any hearing loss. He attended the casualty department at the Royal Victorian Eye and Ear Hospital on 28 February 1980 complaining of postural tinnitus and postural vertigo for 2 months. On clinical examination he had a hearing deficit on the left side. An audiogram revealed a 25 Db sensorineural hearing loss at 400 Hz. Otherwise he was normal, and in particular was fistula negative and Romberg negative. Thirteen days later (12 March 1980) his audiogram was unchanged when he was operated upon. A perilymph fistula was discovered at the anterior-superior margin of the oval window. The surrounding musoca was scarified and the fistula plugged with ear lobe fat. Post-operatively the positional vertigo disappeared. The original low pitched positional tinnitus diminished. His first post-operative audiogram (17 March 1980) showed a slightly increased sensorineural deafness at 3000 and 4000 Hz. At this examination his ear was noted to be bleeding. A repeat audiogram the next day showed a large airbone gap, and increased sensorineural deafness. Until this episode of bleeding from his ear there was little change in his hearing. Presumably the haemorrhage dislodged the fat graft and inflicted damage on his inner ear. Follow up audiograms have shown a steady reduction in the air bone gap (conductive element) and some improvement in the sensorineural deafness.
Description: Journal of the South Pacific Underwater Medicine Society
Date: 1980

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