Table 2.

Proposed diagnostic criteria for perilymphatic fistula (PLF).

Definite PLF
Fluctuating or non-fluctuating hearing loss, tinnitus, aural fullness, and/or vestibular symptoms immediately preceded by one of the following events #1-3, which fulfills Criteria A or B:
Barotrauma caused by external events (e.g., slap/suction to the ear, head trauma, blast, skydiving, underwater diving, or flying, etc.) Barotrauma caused by internal events (e.g., nose-blowing, sneezing, straining, or heavy lifting, etc.) Direct trauma to the inner ear (e.g., Q-tip injury, stapedotomy operation, temporal bone fracture, etc.) Laboratory testing for a perilymph biomarker with high sensitivity and specificity. Observation of perilymph leakage in the middle ear and resolution of symptoms after treatment with intratympanic blood patch or surgical plugging of leak.
Possible PLF
Fluctuating or non-fluctuating hearing loss, tinnitus, aural fullness, and/or vestibular symptoms without antecedent event such as #1-3 above, with third window abnormalities and lack of response to migraine lifestyle, dietary, and prophylaxis therapy, and with resolution of symptoms after treatment with intratympanic blood patch or surgical plugging of leak.