ArticleFrontiers in neurology2026
Popping sound and streaming water-like tinnitus in Cochlin-tomoprotein-confirmed perilymphatic fistula with antecedent barotrauma.
Article in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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; 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.
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