Vacuum results in a change in capillary permeability with transudate and possibly bleeding. If no response, myringotomy. Should take prophylactic measures when flying or diving. Perilymph Fistula Vigorous coughing or straining, sneezing, or nose blowing can result in rupture of the round window or subluxation of the footplate. Leakage of perilymph causes dizziness and hearing loss.
Initial management is bed rest.
If no improvement or if deterioration, surgical exploration is indicated. Progressive hearing loss and otalgia. Physical exam reveals a bluish mass behind the tympanic membrane. Symptoms include aural discharge, bleeding, pain, decreased hearing, and otic polyps. Absence of meatus or external canal ends in blind sac.