Update on idiopathic perilymphatic fistulas.

Idiopathic perilymphatic fistula has been confirmed with clinical-temporal bone histopathologic studies as a separate inner ear disease. Criteria for its diagnosis are sudden or progressive sensory hearing loss, or for vestibular components, a positive fistula test, constant disequilibrium, and positional nystagmus or postural vertigo. Nonsurgical treatment, such as keeping the head higher than the heart and avoiding heavy lifting, can be tried. When it is ineffective or when there is sudden hearing loss without improvement, surgical sealing of the leak should be attempted.