The musician who hears her own footsteps
A 40-year-old professional violinist describes brief vertigo triggered by loud sounds — especially during orchestra rehearsals — and by Valsalva. More distressingly, she has noticed that her own voice sounds unnaturally loud and resonant inside her head (autophony). She also hears her heartbeat in her right ear constantly, her own footsteps as thuds, and occasionally she 'hears' her eye movements. She has normal pure-tone audiometry as far as she has been told.
A 40-year-old professional violinist describes brief vertigo triggered by loud sounds — especially during orchestra rehearsals — and by Valsalva. More distressingly, she has noticed that her own voice sounds unnaturally loud and resonant inside her head (autophony). She also hears her heartbeat in her right ear constantly, her own footsteps as thuds, and occasionally she 'hears' her eye movements. She has normal pure-tone audiometry as far as she has been told.
Which entity should you suspect?
When you play a 110 dB tone at 1000 Hz to her right ear, she experiences vertigo and you observe a brief vertical-torsional nystagmus in the plane of the right superior canal (Tullio phenomenon). Valsalva produces similar symptoms (Hennebert sign). Audiogram shows normal air conduction but supranormal bone conduction at low frequencies on the right.
Best confirmatory test?
Superior semicircular canal dehiscence (right)
- 1.Radiographic prevalence of SSCD is ~1-2%; symptomatic dehiscence is much less common.
- 2.The 'third window' hypothesis: bone loss over the superior canal allows acoustic and pressure energy to dissipate through the labyrinth, producing vertigo with sound (Tullio) and pressure (Hennebert).
- 3.VEMP findings: lowered cervical VEMP thresholds (more sensitive than normal) and elevated ocular VEMP amplitudes (saccular response transmitted abnormally) on the affected side.
- 4.Surgical plugging or resurfacing (middle fossa or transmastoid approaches) resolves vestibular symptoms in most cases; reserved for disabling symptoms because of small risks to hearing.