AURAL VERTIGO TRIAL
AURAL VERTIGO WINDOWS

AURAL VERTIGO WINDOWS

Both the oval and round windows were examined under microscopic visualization and no gross fistula or accumulation of fluid was identified. Adhesions were taken down around the stapes and round window. She underwent right middle ear exploration.

AURAL VERTIGO TRIAL

It was suspected that the patient had a perilymphatic fistula, especially after an empiric trial of diuretics for endolymphatic hydrops (Meniere's disease) provided no relief. MR imaging was performed to evaluate the brain stem and cerebellum however, it findings were unremarkable. Electronystagmography with fistula testing showed no objective abnormal findings however, the patient reported vertigo during application of pressure to the right external auditory canal. Audiometric evaluation revealed very mild conductive hearing loss on the right with normal discrimination, tympanometry, and acoustic reflexes. Normal laboratory values included complete blood cell count, sedimentation rate, rheumatoid factor and complement levels, as well as normal titers for antinuclear antibody, rapid plasmin reagin (syphilis), and lyme disease. Otologic and neurologic examinations were unremarkable. Subsequent episodes occurred sporadically, but were also induced by loud noise, quick head turns, or alterations in pressure (such as change of altitude while flying, or pressure in her right external auditory canal during application of a cotton swab). The initial event followed a coughing spell. These attacks lasted 10 to 15 seconds and occurred over a 3-year period. Only after failed medical therapy and an unrevealing surgical exploration of the middle ear was the diagnosis of dehiscence of the roof of the superior semicircular canal made on the basis of CT findings.Ī 33-year-old woman presented with episodes of a sense that the world was “spinning,” high-pitched tinnitus, and a feeling of fullness in the right ear. We cite a patient who presented with the Tullio phenomenon and Hennebert's sign. In patients presenting with sound- or pressure-induced vestibular symptoms, a new entity has recently been suggested by Minor et al (9) in which the third “mobile” window is attributed to a defect in the roof of the superior semicircular canal. Fistulas of the labyrinth, such as may occur with cholesteatomas and surgical fenestration of the lateral semicircular canal that in the past were performed to treat otosclerosis, are examples of third “mobile” windows (9). The first two “mobile” windows are the oval and round windows. The Tullio phenomenon and Hennebert's sign may arise in some cases from the development of a third “mobile” window within the bony labyrinth (8, 9), which permits transmission of vibration into the vestibular apparatus, producing the sensation of vertigo. Hennebert's sign (nystagmus owing to applied pressure in the external auditory canal) may also occur in perilymphatic fistulas (6) and Meniere's disease (7). The Tullio phenomenon (sound-induced vertigo or nystagmus or both) is historically associated with syphilis, and has been reported in perilymphatic fistulas (1), Meniere's disease (2), congenital deafness (3), chronic otitis media (4), and lyme disease (5). Referrer to state reason if not able to include mandatory information in referral (e.g.In certain pathologic states, sound or pressure transmitted to the inner ear may inappropriately activate the vestibular system. If unable to attach reports, please include relevant information/findings in the body of referral

Outcome of any vestibular physiotherapy assessment (where available and providing it will not cause significant delay).

Audiology and audiogram results (where available and providing it will not cause significant delay).

Vestibular examination (including Dix Hallpike test).

Previous investigations/imaging results.Details of current and previous treatment and outcome.Episodic or continuous associated ear / tinnitus / hearing / neurological symptoms.Relevant history, onset, duration and frequency of symptoms including:.Mandatory referral information (referral will be returned if this information is not included) Episodic vertigo with autophony, nose blowing/straining or noise induced vertigo (suspicion of perilymph fistula / superior canal dehiscence).Unilateral tinnitus, unilateral hearing loss, fluctuating hearing, aural fullness, and at least 2 episodes of vertigo lasting more than 20 minutes (suspicion of Meniere’s disease).First episode of acute vertigo lasting hours with hearing loss (suspicion of vestibular labyrinthitis).First episode of acute vertigo lasting hours with no other obvious cause (suspicion of vestibular neuronitis).Positional vertigo lasting seconds to minutes (suspicion of benign paroxysmal positional vertigo (BPPV)).

Aural vertigo