Use of sound therapy in management of tullio phenomenon associated with unilateral endolymphatic hydrops

<p><strong>Background:</strong> The tullio phenomenon consists of the production of vestibular signs or symptoms by an acoustic stimulus. TP was found to be present in many inner ear pathologies such as superior semicircular canal dehiscence, perilymphatic fistula and endolymphatic hydrops. No previous study probed the value of tinnitus maskers in the alleviation of Tullio phenomenon associated with endolymphatic hydrops.</p><p><strong>Methods</strong>: Twenty one patients who had a confirmed unilateral endolymphatic hydrops associated with Tullio phenomenon were selected for the study. Their age ranged from 20 to 52 years old. Tinnitus masker±amplification was used according to the audiological findings of each patient. The device was used in the affected ear for a minimum of 6 months.</p><p><strong>Results:</strong> Ten patients reported marked improvement on a graded scale with a mean of 8.6±1.2 as regards the occurrence of tullio phenomenon. Six patients achieved an average amelioration (mean 5.9±0.12) while five patients reported failure of the device (mean 3.4±0.6).</p><p><strong>Conclusions:</strong> Sound therapy using tinnitus masker±amplification is a good tool for alleviation of tullio phenomenon associated with unilateral endolymphatic hydrops.</p>

Diagnosis and Management of Vestibular Disorders

This chapter reviews clinical features of eye movement disorders associated with vestibular disorders. The clinical history and examination are reviewed, pointing our key symptoms and signs (with illustrative video cases), for example, in distinguishing vertigo due to stroke from peripheral vestibular disease. Acute vertigo is discussed, including forms due to infections, trauma, and toxins as well as Tullio phenomenon, fistula, canal dehiscence. Recurrent vertigo is reviewed, including Ménière’s syndrome, otosclerosis, inflammatory disorders, migraine, vascular disorders, and epilepsy. The mechanism of hyperventilation-induced vertigo and nystagmus is discussed. Posturally induced vertigo is reviewed, detailing features and treatment of benign paroxysmal positional vertigo (BPPV), and central causes of positional vertigo. The symptom of oscillopsia is reviewed, whether due to an abnormal vestibulo-ocular reflex or paresis of extraocular muscles, or due to nystagmus and other abnormal eye movements. Finally, the topological diagnosis and pathogenesis of skew deviation and the ocular tilt reaction are discussed.