An Osteoma of the Middle Ear Presenting with the Tullio Phenomenon

Abstract

The Tullio phenomenon is an extremely rare condition in which loud noise induces a brisk vestibular response. Osteomas of the middle ear cleft are also uncommon. We report a patient with an osteoma of the middle ear cleft that became symptomatic with progressive facial palsy and mixed hearing loss. The onset was heralded by the Tullio phenomenon, which she had experienced for 10 years. The differential diagnosis of the Tullio phenomenon and the management of middle ear osteomas are discussed.

Middle Ear Osteoma With Assimilation of Ossicles: An Unusual Case of Conductive Hearing Loss

“…Most reported cases have been treated with surgical excision of the osteoma, with respect to their location and structures involved [8]. Given that osteomas tend to grow very slowly, certain centers have advocated for close monitoring instead of surgery, particularly if invasive management would potentially compromise the inner ear and facial nerve [6,12,13]. In this instance, it was felt that the optimal surgical approach would be to perform a mastoidectomy for full visualization, with a stapedectomy to disarticulate the osteoma from the stapes footplate.…”

Middle ear osteoma: case report and review of literature

“…It has been reported that middle ear osteomas may present with other manifestations such as vestibular manifestations, facial palsy, mixed hearing loss, Tullio phenomenon, otorrhea, discharge and tinnitus. 3,[6][7][8] CT scan is the recommended complementary image as it defines the extent and probable origin of the lesion also detecting any secondary manifestations of the tumor. 2 The promontory is the most commonly involved site, followed by incus, pyramidal process, and the anterolateral wall of the epitympanum.…”

Biomechanics of Third Window Syndrome

“…Hennebert's studies of these patients described eye movements evoked by pressure changes in the external auditory canal, a phenomenon now termed "Hennebert's sign" (8). Since these studies, various causes of the Tullio phenomenon and Hennebert's sign have been reported, such as perilymphatic fistula (9, 10), Ménière's disease (11), and cholesteatoma (12). However, the most common cause is superior semicircular canal dehiscence.…”