Disruption of the oval or round window causing inner-to-middle ear perilymph leak.
Precipitated by head trauma (temporal bone fracture), barotrauma (scuba diving, flying), or sudden ↑ ICP / Valsalva (coughing, sneezing, heavy lifting).
Clinical Presentation:
Episodic vertigo and imbalance triggered by pressure changes or straining.
Fluctuating or progressive unilateral sensorineural hearing loss (SNHL), tinnitus, and aural fullness.
Hennebert sign: Vertigo or nystagmus provoked by pneumatic otoscopy (pressure on the TM). c
Tullio phenomenon: Sound-induced vertigo or nystagmus.
Diagnosis:
Initial: Audiometry (documents SNHL) and pneumatic otoscopy.
Imaging: Temporal bone HRCT (evaluates for temporal bone fracture, pneumolabyrinth; rules out superior canal dehiscence).
Gold Standard: Exploratory tympanotomy (direct visualization of perilymph fluid leak).
High-Yield Differentials:
Ménière disease: Episodic vertigo + low-frequency SNHL; not provoked by Valsalva, trauma, or loud sounds.
BPPV: Brief (<1 min) vertigo strictly triggered by head position changes; hearing is preserved.
Superior semicircular canal dehiscence (SSCD): Shared Tullio/Hennebert signs, but classic for autophony; bony defect confirmed on HRCT.
Management:
First-line (Conservative): Strict bed rest with HOB elevated (30–40°), avoidance of straining/Valsalva/heavy lifting, stool softeners, and short-term antiemetics.
Second-line / Refractory (Surgical): Tympanotomy with surgical tissue patching indicated for progressive/severe SNHL or symptoms failing conservative therapy after 1–2 weeks.
Complications:
Permanent, irreversible SNHL, chronic disequilibrium, and retrograde inner-ear meningitis.