Bertholon Pierre, Reynard Pierre, Lelonge Yann, Peyron Roland, Vassal François, Karkas Alexandre
Centre Hospitalier Universitaire de Saint Etienne, 42055, Saint Etienne cedex 2, France.
Eur Arch Otorhinolaryngol. 2018 Feb;275(2):629-635. doi: 10.1007/s00405-017-4781-7. Epub 2017 Nov 8.
Hearing of eyeball movements has been reported in superior semicircular canal dehiscence (SSCD), but not hearing of eyelid movements. Our main objective was to report the hearing of eyeball and/or eyelid movements in unilateral SSCD. Our secondary objective was to access its specificity to SSCD and discuss the underlying mechanism. Six patients with SSCD who could hear their eyeball and/or eyelid movements were retrospectively reviewed. With the aim of comparisons, eight patients with an enlarged vestibular aqueduct (EVA), who share the same mechanism of an abnormal third window, were questioned on their ability to hear their eyeball and/or eyelid movements. Three patients with SSCD could hear both their eyeball and eyelid movements as a soft low-pitch friction sound. Two patients with SSCD could hear only their eyelid movements, one of whom after the surgery of a traumatic chronic subdural hematoma. The latter remarked that every gently tapping on the skin covering the burr-hole was heard in his dehiscent ear as the sound produced when banging on a drum, in keeping with a direct transmission of the sound to the inner ear via the cerebrospinal fluid. One patient with SSCD, who could hear only his eyeball movements, had other disabling symptoms deserving operation through a middle fossa approach with an immediate relief of his symptoms. None of the eight patients with EVA could hear his/her eyeball or eyelid movements. Hearing of eyeball and/or eyelid movements is highly suggestive of a SSCD and do not seem to occur in EVA. In case of radiological SSCD, clinicians should search for hearing of eyeball and/or eyelid movements providing arguments for a symptomatic dehiscence. The underlying mechanism is discussed particularly the role of a cerebrospinal fluid transmission.
已有报道称，在上半规管裂（SSCD）患者中存在眼球运动听觉，但未提及眼睑运动听觉。我们的主要目的是报告单侧SSCD患者的眼球和/或眼睑运动听觉情况。次要目的是评估其对SSCD的特异性，并探讨潜在机制。我们对6例能听到眼球和/或眼睑运动声音的SSCD患者进行了回顾性研究。为作比较，我们询问了8例具有相同异常第三窗机制的大前庭导水管（EVA）患者是否能听到眼球和/或眼睑运动声音。3例SSCD患者能听到眼球和眼睑运动声音，呈轻柔的低音调摩擦声。2例SSCD患者只能听到眼睑运动声音，其中1例是在创伤性慢性硬膜下血肿手术后出现这种情况。该患者称，在其裂开耳中，轻敲覆盖骨窗的皮肤时听到的声音就如同敲鼓时发出的声音，这与声音通过脑脊液直接传入内耳相符。1例只能听到眼球运动声音的SSCD患者有其他致残症状，通过中颅窝入路手术症状立即缓解。8例EVA患者均听不到眼球或眼睑运动声音。听到眼球和/或眼睑运动声音高度提示为SSCD，似乎不会出现在EVA患者中。对于影像学诊断为SSCD的病例，临床医生应检查是否存在眼球和/或眼睑运动听觉，以支持症状性骨裂的诊断。本文讨论了潜在机制，尤其是脑脊液传导的作用。
