アプミ骨手術後にみられたＴｕｌｌｉｏ現象例

Abstract

A 29-year-old male had complained of bilateral hearing loss and bilateral tinnitus since five years ago. He was diagnosed with otosclerosis, and a stapedotomy was performed in the right ear two years ago at another hospital. Following surgery, he complained of oscillopsia during loud sounds. His eye movements were subsequently recorded, during loud sound stimulation. With left ear stimulus nystagmus was not detected, but with right ear stimulus, pendular nystagmus in the vertical plane was seen with sounds of 500Hz 100dBHL. An exploratory tympanotomy was subsequently performed. Except for findings associated with poststapedotomy, there was no evidence of abnormalities, including leakage of perilymph. We thought that the piston wire might be stimulating the labyrinth membrane, so the wire was removed, together with the footplate. The oval window was closed with a vein graft and allograft stapes were inserted in the inverted position. Tullio's phenomenon with downbeat and torsional nystagmus was seen during one month after surgery.Although the origin of vertical eye movement is unclear, observations suggest that Tullio's phenomenon in this case was caused by hyperexcitability of the otolith organs.