Perilymphatic fistula is suspected on clinical symptoms, but must be confirmed by surgery. Exploratory tympanotomy was realized in 38 patients, presenting one or several symptoms of perilymphatic fistula. A leak was observed in 23 patients (61%). When a leak was not observed, the oval and round windows were filled with connective tissue. Preoperative and post-operative symptoms were compared in patients with or without leak: there was not significant difference between the two groups of patients. 63% of patients presenting fluctuant or sensorineural hearing loss improved or stabilized hearing after surgery. One patient, presenting a post-traumatic total deafness due to round window rupture, was immediately operated on, and recovered normal hearing. 84% of patients with vertigo or dizziness improved after surgery. The authors conclude that exploratory tympanotomy should be widely proposed when a perilymphatic fistula is suspected. Oval and round window should be grafted with connective tissue even if a leak is not observed.