A 47-year-old patient reported, “I have been able to hear my eye movements in my left ear for 3 years. When I sneeze I get a short attack of vertigo.” When vibration sense was tested by tuning fork (placing it on the sternum and medial malleolus), the patient heard the sound in his left ear (video 1), indicative of autophony, typical for superior canal dehiscence syndrome. Diagnosis was proven by fistula tests (video 2), vestibular evoked myogenic potentials,1 and CT scan2 (supplementary material). Testing vibration sense can contribute to the diagnosis of vertigo and detection of the affected ear.
Video 1
Testing of vibration sense while placing the tuning fork on the sternum and on the medial malleolus: the patient could hear the sound in his left ear.Download Supplementary Video 1 via http://dx.doi.org/10.1212/008254_Video_1
Video 2
Pressing against the closed nostrils induces a short vertical clockwise torsional nystagmus, typical of left superior canal dehiscence syndrome.Download Supplementary Video 2 via http://dx.doi.org/10.1212/008254_Video_2
Study funding
No targeted funding reported.
Disclosure
M. Strupp is Joint Chief Editor of the Journal of Neurology, Editor-in-Chief of Frontiers of Neuro-otology, and Section Editor of F1000; has received speaker's honoraria from Abbott, Actelion, Auris Medical, Biogen, Eisai, Grünenthal, GSK, Henning Pharma, Interacoustics, Merck, MSD, Otometrics, Pierre-Fabre, TEVA, and UCB; is a shareholder of IntraBio; and acts as a consultant for Abbott, Actelion, Auris Medical, Heel, IntraBio, and Sensorion. A. Zwergal serves as an Associate Editor for Frontiers in Neurology and received speaker's honoraria from Dr. Willmar Schwabe GmbH and Bayer Pharma AG. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
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Teaching slides links.lww.com/WNL/A969
- © 2019 American Academy of Neurology
Letters: Rapid online correspondence
- Author response: Teaching Video NeuroImages: Use your tuning fork to diagnose vertigo
- Reader response: Teaching Video NeuroImages: Use your tuning fork to diagnose vertigo
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