Perilymphatic Fistula

Greetings, learned doctors. It appears I may have suffered from a perilymph fistula in my right ear brought on by deadlifts roughly 3 weeks ago. After the set, I had pretty intense ringing, vertigo, a feeling of my ear being filled with fluid, and sensitivity to certain sounds. It is worth noting that after the event, I gave it a couple weeks before seeing the doctor to see if it went away on its own. During this time, I continued to train as usual. The vertigo and fluid feeling have subsided, but the ringing continues to persist. I have since gone to the PCP and ENT, and the ENT is leaning towards a perilymph fistula. it looks as though next steps are an MRI to rule out anything else then likely a CT scan to see if that turns anything up.

Now that I have seen the PCP and ENT, I have been told to stop lifting weights completely for the time being while we continue to diagnose the issue. Additionally, I have been told that there is a chance I’ll have to stop “heavy” strength training foreverrrrrrrrrrr.

So what say you to this? Having spent some time following your teachings, I tend to question any direction to stop training, but the logic seems sound here - lifting potentially led to the issue and will potentially perpetuate/worsen it.

Am I condemned to a life of cardio and resistance bands?

Is there any training that MIGHT be ok for me to do in the meantime since it will be weeks, if not months, before I get this sorted out?

I know all of it is too early to tell, but I’m really unhappy at the prospect of giving up on strength training.

I’ve heard of occasional case reports of this condition, though I’ve never experienced or treated it myself. My understanding is that a bit of a layoff period may facilitate healing; if not, a surgical patch is sometimes performed (if there are any otologists in the house, please correct me).

This ultimately comes down to taking the symptoms you are experiencing, and performing a “risk / benefit” assessment. I.e., comparing the symptoms you experience (or whatever risks an ENT may be able to forecast for you) versus the benefits you get from training.

Otherwise, this condition is outside my area of expertise, unfortunately.

The ENT prescribed a prednisone taper and a layoff on physical activity. I am halfway through the 12-day prescription, and symptoms do not seem to be decreasing. After the series of scans and whatever else they want to do in order to diagnose this, the likely result is surgery. However, it’s apparently very hard to diagnose, though, so surgery may or may not be the result. It sounds to me like you go into surgery with fingers crossed that the problem really is in fact a perilymph fistula and hope that you’re right. Now there is some fun risk acceptance!

That said, depending on if surgery is the chosen route and how successful that is, I have been told that long term risks are that lifting will potentially continue to perpetuate the problem, potentially resulting in permanent ringing and hearing loss as stress is continually placed on the two small membranes in the middle ear during subsequent training sessions.

Hi David - similar experience here. How are you getting along? It took me 3-5 weeks for dizziness to subside from each PF tear (yes, I’ve had several…)

Mine popped during heavy overhead barbell press - going for my max, straining, holding breath. I was quickly hit by distorted sounds and dizziness. Lasted weeks. ENT was reluctant to diagnose PF - hand-waved it away as a virus or Meniere’s.

Yet, upon deadlifting again, I relasped… weeks of dizziness after only a 75kg deadlift.

This happened twice more over the years until I learned my lesson: no heavy barbell lifts, no holding breath during workouts. Each time I would deadlift upwards of 75kg, boom - dizziness again for weeks. I imagine that past a certain point, the internal pressure is high enough to re-tear the weakened membrane. Happened on deadlifts even when breathing freely btw.

HOWEVER - I haven’t let this stop me from lifting. I just had to adapt. The re-tear happens when I do full-body barbell lifts - so bench/overhead press, squat and deadlift are out.

BUT I can still do a lot of single arm and single leg exercises - 1 arm DB rows, pullups, plenty of upper body isolation work - curls/raises/extensions etc, pistol squats, calf raises, heavy kettlebell swings (up to 40kg for 120 reps now - has given me iron glutes).

I am super aware of my breathing and NEVER hold my breath. I go for a bodybuilder pump, and HIIT conditioning, rather than strength.

The key is work your body in smaller sections, and avoid that “full-body, high pressure” lifting (i.e. barbells) that causes the membrane to re-tear.

I can at least maintain nice muscle mass and fitness this way, even if I’m no longer ‘barbell strong’. I do miss heavy strength training – but I can at least still lift, my arms are the biggest they’ve ever been, and I’m fit as hell from the KB swings.

It definitely beats PF symptoms which were just miserable.

Hope that helps. All the best with healing and sensible training.