Positional nystagmus and benign paroxysmal positional vertigo often are associated with traumatic perilymph fistula. Sensorineural hearing loss may be confirmed by audiograms. A CT scan or MRI may be indicated if temporal bone fracture is considered. Their use as diagnostic studies for nontraumatic perilymph fistulas is questionable. Positive results include the elicitation of nystagmus or onset of dysequilibrium with the sensation of motion or nausea.
Some otologists administer the test with electronystagmography or using a specialized platform.
Rigid or flexible endoscopy to seek visible tears or fluid in the middle ear Perilymph labeling methods have been studied, primarily using intrathecal or intravenous fluorescein. Identification of perilymph fluid by objective testing, such as tests for the protein beta2-transferrin, may improve diagnostic accuracy in the future. The final diagnosis is made by direct inspection at the time of surgery, upon visualizing the perilymph fluid in the middle ear cavity. The subjectivity of this diagnostic maneuver has been questioned. More objective tests are being developed, particularly those that identify compounds specific to perilymph upon the examination of the fluid contents.