Head trauma, including whiplash injuries. The existence of spontaneous perilymph fistula is still an area of controversy among otologists. A CT or MRI may be indicated if temporal bone fracture is considered. Their utility as diagnostic studies for non-traumatic perilymph fistula 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 looking for 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 beta 2 transferrin, may improve diagnostic accuracy in the future. The final diagnosis is made by direct inspection at the time of surgery, visualizing the perilymph fluid in the middle ear cavity. The subjectivity of this diagnostic maneuver has been questioned.