Click-evoked vestibular activation in the Tullio phenomenon.

Abstract

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.

Potencial evocado miogênico vestibular (Vemp): avaliação das respostas em indivíduos normais

“…Regarding the acoustic stimulus, a variety of frequencies have been described. However, frequencies equal to or below 5 Hz are the most often used and evoke more homogeneous, constant responses.. 5,8,9,21 Response characteristics depend upon the type of stimulus administered. According to a number of studies, vestibular myogenic potentials evoked by tone bursts require a lower stimulation threshold than evocation by clicks.15,22 Placement of the electrodes on the surface of the SCM muscle has been the most often employed method, for, according to the literature, the responses are more consistent and homogeneous; it is also a more practical method for the examiner and more comfortable for the patient.…”

“…The first biphasic potential has a positive peak (P) with a mean latency of 13 milliseconds (ms), followed by a negative peak (N) with a mean latency of 23 ms, denominated P13-N23 or P14-N21 or P1-N2 (FIGURE 1). [2][3][4][5][6] The amplitude of the potential reflects the magnitude of the muscle reflex.8 However, as there is considerable individual variation in the magnitude of this response stemming from intraindividual variations in muscle mass and tone, the asymmetry index of the response is used. [8][9][10] This index compares the affect of muscle tone from one side to the other and is calculated by the inter-aural difference in amplitude of the response, measured by the mean response of each patient.9,10.…”

Sound- and/or Pressure-Induced Vertigo Due to Bone Dehiscence of the Superior Semicircular Canal

“…Ostrowski et al 27 reported ocular torsion induced by pressure in the external canal in 3 patients. Colebatch et al 28 reported click-evoked vestibulocollic reflexes at a lower threshold from the symptomatic ear in a patient who developed the Tullio phenomenon after forceful sneezing.…”

Superior semicircular canal dehiscence syndrome as assessed by oVEMP and temporal bone computed tomography imaging

“…Cervical vestibular evoked myogenic potentials (cVEMP) have been clinically used for vestibular evaluation since the first report of surface potentials from the sternocleidomastoid muscles (SCM) in response to loud clicks [1][2][3][4]. Recent studies have shown that short latency potentials (nI and pI), referred to as extraocular vestibular evoked myogenic potentials (oVEMP), can be recorded from around the eyes [5][6][7].…”