Perilymph fistula presenting with contralateral symptoms.

OUTCOME OBJECTIVES: To report the case of a contralateral Tullio phenomenon, suggest possible pathophysiology, and give insight into normal vestibular physiology.

PATIENTS: Twenty-year-old female subject who presented with 8-month symptoms of left-sided Tullio phenomenon after a motor vehicle collision. Testing suggested a right perilymphatic fistula.

INTERVENTION(S): Bedrest and a right perilymphatic fistula repair.

MAIN OUTCOME MEASURE(S): Cervical vestibular evoked myogenic potentials (cVEMPs), audiometry, and patient symptoms.

RESULTS: Postoperatively, the patient's symptoms of left-sided Tullio phenomenon abruptly abated, and the patient reported no activity limitations. Vertigo and phonodynia could not be reproduced. Postoperative VEMP demonstrated marked normalization (from abnormally decreased right-sided threshold and increased amplitude preoperatively). The left continued to demonstrate no abnormalities on audiogram, tympanogram, or VEMP.

CONCLUSION: This is the first known report of symptoms presenting contralateral to the side of perilymph fistula and represents a window of understanding to vestibular physiology. The cause of this unique finding may rest in the failure of commissural inhibition after labyrinth dysfunction. Clinicians should maintain heightened awareness for the possibility of inner ear dysfunction contralateral to symptoms.