Popping sound and streaming water-like tinnitus in Cochlin-tomoprotein-confirmed perilymphatic fistula with antecedent barotrauma.

BACKGROUND: Perilymphatic fistula (PLF) after barotrauma has been linked to popping sounds, streaming water-like tinnitus, and fistula signs, but objective evidence is limited. AIMS/OBJECTIVES: To determine whether these features are associated with Cochlin-tomoprotein (CTP)-confirmed PLF after antecedent barotrauma. MATERIALS AND METHODS: We retrospectively analyzed 149 category 2 (external barotrauma) or category 3 (internal pressure-related barotrauma) cases among 736 patients who underwent CTP testing at 80 Japanese institutions. Frequencies of clinical features were compared by CTP status using Fisher's exact test. RESULTS: CTP positivity was 17% in category 2 and 22% in category 3. In category 2, CTP positivity was higher in patients with a popping sound than in those without it (60% vs. 12%; OR, 10.88; 95% CI, 1.63-68.66; p = 0.035). In category 3, CTP positivity was higher in patients with streaming water-like tinnitus than in those without it (41% vs. 16%; OR, 3.75; 95% CI, 1.30-10.31; p = 0.019) and in patients with nystagmus than in those without it (30% vs. 12%; OR, 3.12; 95% CI, 1.18-8.70; p = 0.033). Fistula signs were not associated with CTP positivity. CONCLUSIONS AND SIGNIFICANCE: Symptom profiles differed by barotraumatic mechanism in CTP-confirmed PLF. A popping sound may represent a characteristic clinical clue suggestive of PLF after external barotrauma, whereas streaming water-like tinnitus and nystagmus may better indicate PLF after internal pressure-related events, although the observed associations in this study were exploratory and not adjusted for multiple comparisons. Absence of a fistula sign should not exclude PLF.