Click-evoked vestibulocollic reflexes were studied in a patient with a unilateral Tullio phenomenon (sound induced vestibular symptoms) and the findings were compared with those of a group of normal subjects. Compared with normal subjects, the reflexes elicited from her symptomatic side were large and had an abnormally low Subjects and methods CASE HISTORYThe patient, a 55 year old woman, reported that she had experienced left retroauricular pain and impaired balance after a series of forceful sneezes six years previously. Pressure over the mastoid area or loud sounds made her feel unsteady and veer to the left, and also made her retroauricular pain worse. Associated with these symptoms was the illusion of objects "swimming" in front of her. Clinical examination of her eye movements as well as the remainder of the neurological examination were normal. The Hallpike manoeuvre was negative bilaterally. Loud tones (1 kHz, 110 dB ISO) presented to the left ear through earphones caused visible nystagmus. This consisted mainly of conjugate torsional left beating and down beating components.11 Similar loud sounds presented to the right ear did not cause nystagmus. Pure tone audiograms, stapedial reflex thresholds, bithermal caloric tests, CT of the temporal bone, and cranial MRI were normal. The middle ear was normal when surgically explored (HL).Click stimuli were delivered through earphones with the patient sitting.

Benign paroxysmal positional vertigo (BPPV) is a self-limiting condition characterized by vertigo and nystagmus induced by certain head positions. The most common causes of BPPV are post-traumatic following head injury and post-viral labyrinthitis. We present an interesting case of BPPV following an otherwise uneventful neurosurgical removal of a parietal osteoma using hammer and chisel. Caution should be exercised during such procedures as disabling vertigo can result for a considerable period of time.

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Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.

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