The Vestibular Migraine & Secondary Hydrops Community
Read our welcome post, user support wiki & visit our member recommended products page

Fluid in eustacian tube


I respect your privacy. Not a problem.

Are you aware of idiopathic reasons causing secondary endolymphatic hydrops ?

A little more clarification. Primary hydrops is classic meniere’s. Secondary is more chronic and a pain in the ass with constant imbalance . Secondary is usually trauma based. Hence my question on can hormones, high cholesterol and such cause SEH. Classic meniere’s tends to be more episodic and causes low frequency hearing loss.


Good stuff on the collagen. Never knews this before. Thanks for sharing.

Also permanent fistula should manifest with degrading hearing. This would also keep the longitudinal flow of CSF perennial. Would this be the only case to opt for surgery?


Idiopathic = “without a known cause”. So - to answer your question: it’s a little bit of a misnomer. There are a number of things that have been established as possible causes of secondary endolymphatic hydrops.

Secondary endolymphatic hydrops appears to occur in response to an event or underlying condition. For example, it can follow head trauma or ear surgery, and it can occur with other inner ear disorders, allergies, or systemic disorders (such as diabetes or autoimmune disorders). Source: Secondary Endolymphatic Hydrops by Susan Pesznecker of VeDA (2017).


The precise mechanism by which perilymph loss produces hearing loss is unclear. Decompression of the perilymphatic space may create secondary endolymphatic hydrops. Consequently, the usual symptoms of endolymphatic hydrops (Ménière disease) arise. Secondary endolymphatic hydrops has been histologically identified in experimental animals with perilymphatic fistula (PLF). Compelling indirect evidence exists that hearing loss in this circumstance is the result of loss of perilymphatic pressure. A large number of reports describe hearing loss associated with decreased subarachnoid pressure secondary to spinal anesthesia. Hardy demonstrated that such hearing loss can be reversed by injecting 20 mL of isotonic sodium chloride solution into the subarachnoid space. Source: Perilymphatic Fistula by Kutz (2018).

Now to this:

While it’s certainly possible, I don’t believe it’ll degrade hearing considerably unless it’s severe enough to cause a sufficient skewing of inner ear fluid pressures or volumes.

Keep in mind these charts of the most commonly-reported symptoms in patients with PLF:

Source: Black et al. - Perilymph Fistulae (2001)

Source: Wackym - Perilymph Fistula - Otic Capule Defects Not Seen With Imaging (2016)

Lastly, check this out:

[2018] Deveze et al. - Diagnosis and Treatment of Perilymphatic Fistula.pdf (1.3 MB)

… and this (all docs I have—mostly focused on PLF—that contain the exact phrase “secondary endolymphatic hydrops”):

[2001] Fitzgerald - Perilymphatic Fistula and Meniere’s Disease.pdf (61.4 KB)
[2017] Pesznecker - Secondary Endolymphatic Hydrops.pdf (123.8 KB)
[1987] Allen - Fluid flow in the cochlear aqueduct and cochlea-hydrodynamic considerations in perilymph fistula, stapes gusher, and secondary endolymphatic hydrops.pdf (81.4 KB)
[2018] Kutz - Perilymphatic Fistula.pdf (214.2 KB)
[2015] Choi et al. - Audiovestibular impairments associated with intracranial hypotension.pdf (353.0 KB)
[1995] Fitzgerald. - Persistent Dizziness Following Head Trauma and Perilymphatic Fistula.pdf (481.0 KB)
[1993] Morris et al. - Magnetic Resonance Imaging of Perilymphatic Fistula.pdf (774.3 KB)
[1997] Fitzgerald et al. - Perilymphatic Fistula - A Washington DC Experience.pdf (885.4 KB)
[1988] Arenberg - ECoG results in perilymphatic fistula - Clinical and experimental studies.pdf (1.0 MB)
[2012] Greco et al. - Meniere’s disease might be an autoimmune condition?.pdf (1.3 MB)
[1997] Weider - Tinnitus - Report of Ten Cases of Perilymphatic Fistula and:or Endolymphatic Hydrops Improved by Surgery.pdf (1.3 MB)
[1999] Friedland & Wackym - A Critical Appraisal of Spontaneous Perilymphatic Fistulas of the Inner Ear.pdf (1.3 MB)
[1994] Weider - Treatment and Management of Perilymphatic Fistula.pdf (1.4 MB)
[1994] Ackley et al. - Perilymphatic Fistula - Historical Perspective.pdf (1.5 MB)
[1991] Black et al. - Surgical Management of Perilymph Fistulas - A New Technique.pdf (2.4 MB)
[1989] Grimm et al. - The Perilymph Fistula Syndrome Defined in Mild Head Trauma.pdf (2.3 MB)


great collection of papers. Thanks for sharing. I was not able to find the full paper below in google. Thanks again

[2018] Deveze et al. - Diagnosis and Treatment of Perilymphatic Fistula.pdf


No worries.

Did the download link I provided for [2018] Deveze et al. - Diagnosis and Treatment of Perilymphatic Fistula.pdf work for you?


yes it did.Thanks. How did you get access to the full paper ?


Secret sources. :wink:


Can’t say.

Check this out:


This too:


wow…great tip !


That symptom profile seems identical to Secondary Hydrops and also to many cases of MAV?

And what you’ve described there is surely Secondary Hydrops? (And that’s what my doctor believed happened to me.). My hearing loss and tinnitus only manifested about 6 months after my ear injury. Migraines came a year after. It’s interesting to note that that injury itself didn’t directly cause migraines but the Hydrops did? That might be personal.

My main symptoms at the time of injury were imbalance and nausea but these resolved within 5 weeks.

May we ask, what is your interest in the subject? Anything happen to you?


Are you referring to the symptoms on the charts by Wackym and Black?

Possibly, but which part?

Interesting. I’m not sure why it went that way for you. There’s a great page here on delayed hydrops by Dr. Hain:

Interesting. It may have been some sort of inner healing, or—of course—the brain compensating. The compensating thing seems to happen better when there’s unilateral damage; bilateral really has the potential to wreak havoc:

Here’s Dr. Hain talking about bilateral vestibular loss:

It’s great how our bodies have redundancy. When it fails, it’s horrifying.

I had pretty severe sudden suction trauma to one ear which was followed by a constellation of symptoms consistent with PLF, minus objective hearing loss.

One month later, my opposite ear began building with a deep pressure, which was only relieved on its own when the sensation of rather profuse fluid leaking from the opposite ear down into my neck happened. That’s when the insane headaches began, and they haven’t let up.

How did your ear injury happen?



Which part?:

“unless it’s severe enough to cause a sufficient skewing of inner ear fluid pressures or volumes.”. You’ve described secondary hydrops.

My stupid injury was caused by pointing a shower into my ear in a ridiculously foolish attempt to clear some wax. I have little doubt the weight of the wax slug might have contributed to the result. There was no damage to the ear drum but my doctor suspects the stapes might have transferred the pressure and punctured the oval window. I have since had the sensation of fluid gathered in my middle ear for three and a half years which is felt in the morning when I get up. Started as a short muffling sensation for a few seconds then went on to become a gurgling then a bubbling. Recently it has significantly abated.

I had very severe headaches/migraines only a year later but they were controlled with Amitriptyline and time. They were so bad I was in bed for 14 hours at a time every 3 days for 3 months or so, only able to stare at a point on the wall. Something from your worst nightmare … anything similar to yours?

My balance took 2.5 years to recover after the first major relapse at the 6 month point.

It’s very easy to relapse. Recently I had a short relapse for half a day because I drank 3 coffees (stupid!). Suspect the Hydrops is lurking and the compensation is on a knife edge.

That’s amazing. I have had symptoms in my ‘good’ ear. I believe there must be a central element to pressure management. I wonder if this is because labyrinths evolved in fish, so there needed to be a way of managing bi-lateral pressure changes due to depth? I suspect you knock this process out of homeostasis when you injure one ear.

Sorry to hear about your injury!

Menieres, Migraine, Nortriptoline

I don’t believe this is the same thing:

“Delayed endolymphatic hydrops consists of new ear symptoms that occur many years after onset of profound deafness”

That statement rules it out of being equivalent to Secondary Hydrops.

In fact Hain doesn’t appear cover Secondary Hydrops as a single topic, which I’ve always found odd.

Another very odd part about Secondary Hydrops is the symptom collection is identical to Migraine Associated Vertigo for a large number of sufferers. Many people here stating they have been diagnosed with MAV and have the very same symptoms. Indeed, I was diagnosed as having MAV by two doctors one who dismissed my trauma! The treatment and the diet are also identical. My doctor said “you may find some trigger foods like cheese or red wine make your hydrops worse” … if you substituted ‘MAV’ for ‘hydrops’ you would hardly have noticed …


Turnitarond, what sort of symptoms have you had in your good ear?


Good ear:

  • Some tinnitus but very very rarely, very mild bubbling on rare occasions, mild pain on occasion, no hearing loss.

Bad ear: almost the shooting match:


  • Fluid sensations (muffling, dripping) mainly for few seconds upon rising out of bed in morning.

Then from 6 months in:

  • Tinnitus
  • Sporadic, periodic shooting ear pain
  • HF hearing loss (mild, no issues with speech resolution)
  • Hearing distortion around loud noises, e.g. from rumbling on the tube/metro (this has eased over the years)
  • Feeling of pressure when in vehicles (ditto)
  • Sound sensitivity (ditto)
  • More fluid sensations (muffling, bubbling, gurgling, mild popping, dripping) (ditto)

… and then of course all the balance stuff, visual vertigo and to top it all migraines (from 12 months in).


Wow, thanks for the fast reply.

What do you mean by ‘bubbling’ in your good ear? Is it like a deep pressure sensation?


Just a sensation that fluid is dripping. Extremely minor and hasn’t bothered me. But I did find it interesting.


Ah gotcha. And all this was only after the injury to the bad ear, yeah?


Someone asked me if PLF could be induced by skyscaper elevator rides. I replied with:

Conceivably, I would think so, though I’m not 100%, sure. I haven’t seen any studies that talk about this.

Check these out:

[2018] Lechner et al. 1.pdf (766.2 KB)
[2018] Lechner et al. 2.pdf (130.3 KB)

They describe barotrauma inducing PLF in SCUBA divers. Also, check this study out: