This study was designed to verify an eventual perilymphatic fistula (PLF) in 264 patients with sensorineural hearing loss (SNHL) and/or vertigo. The patients were exposed to a low-frequency sound stimulation (LFS) on posturography to objectively test Tullio’s phenomenon and Hennebert's sign. Endoscopes with 5 degree and 25 degree of visual angle and an outer diameter of 1.7？mm were used. The round window niche, with its foldings, oval window with stapes superstructure, a part of the facial recess and the area in the fissula ante fenestram were examined and video recorded. In one patient, we endoscopically verified a fistula in the round window membrane (resulting from a diving accident) that was covered with a fibrinous layer. In 4 cases, there was abnormal mucosal shining in the round window but without PLF. In 7 cases, the tympanic cavity could not be visualized because of the adhesive middle ear process, the abnormal anatomy, or the prominent exostoses of the ear canal prohibited vision. In 34 patients, LFS provoked unsteadiness on posturography without PLF. In 6 cases, a postoperative middle ear infection was recorded. No permanent tympanic membrane perforation occurred. It is unlikely that disease entity of “spontaneous PLF” exists. Tympanoscopy should be regarded as the first choice when a PLF is suspected. 1. Introduction Perilymphatic fistula (PLF) is an abnormal communication between the middle ear and the perilymphatic space, mostly due to laceration of the oval and/or round window, or congenital defects in the area of fissula ante fenestram or fossula post fenestram [1]. PLF may be caused by external injury such as head trauma, barotrauma, physical exertion such as straining, nose blowing, sneezing, among others [2]. Some diseases such as Mondini malformation, large cochlear aqueduct syndrome [3], and middle ear abnormalities are linked to PLF [4], among others. When no obvious reasons for PLF exists, it is called spontaneous [5]. This does not mean that spontaneous PLF would occur without trauma, but the trauma may be so minute that it is not recognised. Idiopathic PLF has been implicated as one of the etiological factors associated with idiopathic sudden or fluctuating sensorineural hearing loss and vertigo, which occurs in defined diseases such as Meniere’s disease, otosclerosis, and sudden deafness, among others [6]. So far, there are no objective tests that can exclude or verify a PLF. Thus, the diagnosis of PLF is very symptom-oriented. Clinically, PLF is suspected when the patient complains of the Tullio’s phenomenon [7, 8]. Most
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