목적: The diagnosis of barotraumatic perilymph fistula (PLF) is controversial due to the variability in patient presentation and difficulty in pre-operative evaluation. Symptoms like hearing loss, ear fullness and dizziness can develop following minor barotrauma such as valsalva, nose blowing and straining. The aims of this study are to present the clinical manifestations of barotraumatic PLF for providing appropriate diagnosis and management. 방법:We reviewed medical records of the patients who underwent surgical exploration under the impression of barotraumatic PLF. 17 patients were enrolled and the causes, symptom and signs, and operative findings and outcomes were analyzed. 결과:Among the 17 patients, 5 patients were classified as the external trauma (car accident, slap injury) and 12 patients had internal trauma (lifting, nasal blowing, straining,etc). Every patient was complaining of hearing loss and dizziness after trauma. Mostly, dizziness was followed by hearing loss (n=13). 3 patients showed nystagmus on fistula test and 8 patients showed positional nystagmus mimicking benign paroxysmal positional vertigo (BPPV). However, the positional nystagmus was not typical to BPPV. Direction of nystagmus was changed over time. In addition, there is no reversibility and fatigability. After OW and RW obliteration, dizziness was improved immediately after surgery in most patients. However, hearing loss was improved in 10 cases out of 17 patients. 결론:The clinical presentation of barotraumatic perilymph fistula could be variable depending on location of fistula (OW or RW) and degree of damage. It could present as hearing loss with positional dizziness mimicking sudden hearing loss with BPPV. The differential diagnostic points were history of barotrauma, time sequence of development of hearing loss and positional dizziness, and atypical positional nystagmus unlike BPPV. In addition, early surgical intervention in clinically suspected PLF seems to be very essential for improvement of symptoms.