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Surgical Treatment of an Endolymphatic Sac Tumor

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Perilymph fistula presenting with contralateral symptoms.

Michael Hermann¹, Daniel H Coelho

¹Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology

|January 23, 2014

Summary

A rare case of contralateral Tullio phenomenon resolved after a right perilymph fistula repair, offering new insights into vestibular physiology and inner ear dysfunction.

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Area of Science:

Otolaryngology
Neuroscience
Vestibular System Physiology

Background:

Tullio phenomenon, characterized by sound-induced vertigo, is typically ipsilateral to the affected inner ear.
Perilymphatic fistula, an abnormal opening between the middle and inner ear, can cause vestibular symptoms.

Observation:

A 20-year-old female presented with left-sided Tullio phenomenon following a motor vehicle accident.
Diagnostic testing indicated a right-sided perilymphatic fistula.

Findings:

Surgical repair of the right perilymphatic fistula led to the complete resolution of the patient's left-sided Tullio phenomenon.
Postoperative vestibular evoked myogenic potential (VEMP) testing showed normalization of the previously abnormal right-sided thresholds.

Implications:

This case is the first reported instance of contralateral Tullio phenomenon, suggesting a potential role for impaired commissural inhibition in vestibular dysfunction.
Heightened clinical awareness is warranted for inner ear issues presenting on the side opposite to the suspected fistula.