PLFs were first recognized as a result of pathologic causes, such as tumors or virulent middle ear or mastoid infections. PLFs were later documented as a complication of otic capsule erosion by cholesteatomas, usually at the lateral extent of the horizontal canal.3,4

Traumatic PLFs have been recognized clinically for more than 100 years.5 PLFs were later identified in military personnel exposed to sudden decompression or blasts and in scuba divers, who presented with sudden hearing loss from round window rupture.6-14 Barotrauma is a well-documented cause of PLFs.13,15-17 Conditions associated with sudden or dramatic changes in ambient air pressure can rupture the oval or round window via

* This work was supported in part by National Institutes of Health grant RO 1 DC00204, NASA grant NAGW-3799, and a grant from the Legacy Portland Hospitals Research Advisory Committee.

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