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a Department of Neurology,
Prince of Wales Hospital, Sydney 2031, Australia, b MRC Human Movement and Balance Unit, c Department
of Neuro-Otology, National Hospital, Queen Square, London, UK
Correspondence to: Dr JG Colebatch, Department of Neurology, Prince of Wales Hospital, High Street, Randwick, Sydney, NSW 2031, Australia. Fax 0061 2 9382 2428.
Received 27 February 1998 and in revised form 7 May 1998;
Accepted 15 May 1998.
OBJECTIVES
The frequency of pathologically reduced
click thresholds for vestibular activation was explored in patients
with the Tullio phenomenon (sound induced vestibular activation).
METHODSSeven patients (eight affected ears) with
symptoms of oscillopsia and unsteadiness in response to loud external
sounds or to the patient's own voice were examined. In all but one
patient, vestibular hypersensitivity to sound was confirmed by the fact that eye movements could be produced by pure tones of 110 dB intensity or less. Conventional diagnostic imaging was normal in all cases and
three of the patients had normal middle ears at surgical exploration. Thresholds for click evoked vestibulocollic reflexes were compared with
those of a group of normal subjects. Galvanic stimulation was used as a
complementary method of examining the excitability of vestibular reflexes.
RESULTSAll the patients showed a reduced
threshold for click activation of vestibulocollic reflexes arising from
the affected ear. Short latency EMG responses to clicks were also
present in posterior neck and leg muscles, suggesting that these
muscles receive vestibular projections. Galvanic stimulation produced a
normal pattern of body sway in four of the five patients tested.
CONCLUSIONSA pathologically reduced threshold to
click activation (
70 dB NHL (average normal hearing level)) seems to
be a consistent feature of the Tullio phenomenon and a useful
diagnostic criterion. This in turn is most likely to be due to an
increased effectiveness of the transmission of sound energy to saccular
receptors. Activation of these receptors probably contributed to
the vestibular symptoms experienced by the patients.
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