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Fistula Test

The fistula test is a clinical vestibular test that detect the presence of abnormal communication between the middle and the inner ear. Common causes are cholesteatoma eroding bony labyrinth and post trauma. When pressure is applied in the external ear by pushing the tragus with finger into ear canal or by using pneumatic Seigle’s speculum, this results in vertigo and nystagmus. The nystagmus can be observed directly or by using Frenzel goggles. This response is called positive fistula test. Labyrinthine fistula is a common complication of cholesteatoma in which lateral semicircular canal is involved in 90% of cases. Fistula test can be false negative in many cases and only one third of the patients with cholesteatoma and labyrinthine fistula exhibit a positive fistula test whereas HRCT can detect fistula in around 82% of cases.