We know about the several causes for Tullio's phenomenon. I would like to the treatment strategy for the same with any Clinical and research experiences?
"We know about the several causes for Tullio's phenomenon."
While it should have been obvious for a very long time that the cause of Tullio's phenomenon was an inner ear fistula, the precise cause(s) have only recently been demonstrated. The management, surgical or otherwise, will depend on the precise defect. Often a diagnosis and clear explanation will suffice, as patients will gain considerable relief from being believed by the doctor, and from reassurance they are not going crazy.
In our experience, the main difficulty in case of associated deafness to provide amplification without increase of vertigo. Avoid the use of unvented earmold and try with precaution with open soft tip . This cannot provide energy in the mow frequencies but in some case a good amplification in the convrsational frequencies will be sufficient
Consider the problem could be superior semicircular canal dehiscence and go from there
One can try keeping the maximum output of the hearing aid just below the VEMP threshold.
"One can try keeping the maximum output of the hearing aid just below the VEMP threshold"
Yes, but this should not deflect attention from trying to find out the cause. Loud sound should not cause vertigo or dizziness, and remedial surgical solutions are increasingly being found for this physiological anomaly.
The surgical solutions are optimal when the dehiscence is big enough to generate invalidating symptoms.
If the patient is not so discapacitated or when there is a near-dehiscence , we find the middle craneal fossa, too agressive for the patient
Perilymphatic fistula and superior canal dehiscence can each produce Tullio, with dehiscence more frequent.
While the causes of Tullio phenomenon are diverse, I believe the commonest we encounter here in sub-saharan Africa is due to Superior canal dehiscience. I agree with Eduardo Martin-Sqnz that surgical options is only beneficial with large dehiscience.
"I believe the commonest we encounter here in sub-saharan Africa is due to Superior canal dehiscience."
Do you think this is commoner in Africa than in America or Europe? If so, why?
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