Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery and and John Carey, MD, Professor, Johns Hopkins Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine
This is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (towards the right ear) nystagmus, suggestive of excitation of the right anterior canal (slow phase down and torsion towards left ear, with position reset/fast phase in the opposite directions). There was more downbeat nystagmus in right gaze, and more torsional (towards right ear) nystagmus in left gaze. Superior canal dehiscence (SCD) was demonstrated on the right side on CT temporal bones and SCD syndrome was diagnosed. Valsalva and pinched-nose/nasal Valsalva maneuvers should be performed when there is a suspicion for SCDS (noise/pressure triggers, autophony + vertigo attacks, etc).
Daniel R. Gold, D.O.
Spencer S. Eccles Health Sciences Library, University of Utah