Perilymphatic fistula of the round window

SummaryObjectiveTo highlight diagnostic and treatment pitfalls in perilymphatic fistula.Case reportsTwo cases of round-window fistula are reported, detailing clinical aspect, treatment and outcome. The triad comprising sensorineural hearing loss, tinnitus and vertigo with associated fistula sign is classical but in fact rarely encountered. Imaging is of limited contribution, but may reveal anatomic abnormalities suggestive of perilymphatic fistula. Outcome is improved by early management, especially in case of moderate hearing loss.Discussion/conclusionDiagnosis of perilymphatic fistula is challenging, but enables effective treatment. On any suspicion, surgical exploration should be undertaken, being the only reliable guide to diagnosis and etiologically adapted management