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Perilymph Fistula (PLF), abnormal communication between the fluid-filled space of the inner ear and the air-filled space of the middle ear, is a significant cause of vestibular and auditory symptoms. This is a retrospective study of 22 cases treated with PLF repair surgery, selected based on our surgical indication. We analyzed the characteristics of these 22 cases and evaluated the efficacy of PLF repair surgery in treating vestibular and auditory symptoms. Cases with antecedent events had significantly shorter intervals before surgery. The postoperative recovery from vestibular symptoms following PLF repair surgery was strikingly rapid, with 82% of cases demonstrating marked improvement within a week, even in chronic cases. Despite the notable absence of a control group in the study, the marked improvements in vestibular symptoms and substantial reductions in Dizziness Handicap Inventory (DHI) scores suggest that the observed benefits are attributable to the surgical intervention. Further, timely surgery showed improvements in hearing, with some benefits also seen in late-stage surgeries. Using the perilymph-specific protein Cochlin-tomoprotein (CTP) as a diagnostic biomarker, we could prove that PLF could be responsible for disequilibrium and related auditory disturbances in these patients. A new hypothesis is proposed that the chronic disequilibrium experienced by many PLF patients is due to enhanced mobility of the utricle and not to endolymphatic hydrops. Further research is needed to fully elucidate PLF's symptoms and treatment efficacy using the surgical indication we developed. [ABSTRACT FROM AUTHOR]

This document is a comment on a previously published article titled "Vestibular Migraine versus Meniere's Disease: Diagnostic Utility of Electrocochleography." The author commends the use of Electrocochleography (EcochG) in distinguishing between the two conditions, although they note that there may be a more appropriate technique than the one used in the study. The author explains that the EcochG technique employed in the study, using a remote electrode and a click stimulus, may not provide accurate results compared to other techniques. They suggest that the lack of standardized EcochG techniques has hindered progress in diagnosing Meniere's disease and differentiating it from vestibular migraine. The author declares no conflicts of interest. [Extracted from the article]