Question
I have a patient in his late 70's who was fitted with binaural hearing aids recently. He reports that whenever he causes the hearing aid to go into feedback by cupping his hand over the hearing aid, he experiences dizziness, and only when doing so in the right ear. I have attempted to mimic loud sounds into this same ear, however the dizziness cannot be elicited. The dizziness appears to be present only with the very specific sound of the feedback caused by cupping the hand over the hearing aid. He has had MRI studies done and everything turned out normal. Any ideas as to what is causing this?
Answer
The patient may be describing Tulio's Phenomena. This has been reported in the presence of Superior Canal Dehiscence Syndrome or SCDS. MRI studies are not very useful in the identification of SCDS. The usual imaging study to identify this entity is a thin cut CT scan which would better image the "missing bony" covering in the superior semi-circular canal. You were on the right track trying to stimulate the right ear with loud sounds. It is possible that the production of feedback by the patient cupping his hand over the ear is producing excessive sound pressure level (dependent on the MPO of the hearing aid) in the small cavity between the ear mold and the TM creating the Tulio's phenomena. A fistula test on the right ear may also elicit the dizziness response. An interesting case to be sure.
Dr. George Cire is a Private Practice Audiologist in Littleton, Colorado. Dr. Cire's clinical interests are in Medical/Diagnostic Audiology, Vestibular Diagnostics and the fitting and measurement of advanced DSP hearing systems. Dr. Cire received his masters degree at LSUHSC in New Orleans and his Au.D at the Arizona School of Health Sciences in Mesa, AZ.
George Cire, AuD
Clinical Manager, Bone Anchored Solutions, Cochlear Americas
George Cire currently works as Clinical Manager of Bone Anchored Solutions for Cochlear Americas in Englewood, Colorado. Prior to joining Cochlear, Dr. Cire has worked as a field specialist for Phonak Hearing Systems and has been a practicing Audiologist for 30 years. He has worked both in stand-alone private practice and as the director of an ENT affiliated Audiology Practice. His specialty interests are in the areas of clinical verification of amplification and vestibular diagnostics and treatment. Dr. Cire received his BA degree from Louisiana Tech University in Ruston, LA, M.C.D. (Master of Communicative Disorders) from Louisiana State University Health Sciences Center, New Orleans, LA and Au.D. from A. T. Still University, Arizona School of Health Sciences in Mesa, AZ.
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