Deecke L, Mergner T, Plester D
Ann N Y Acad Sci. 1981;374:650-5. doi: 10.1111/j.1749-6632.1981.tb30908.x.
A 44-year-old male patient had an acoustic trauma three years previously, after which he suffered from vertigo and tilting of the environment to the right when uttering the vowels u or e. At such times, a tonic eye torsion to the left, which lasted throughout the utterance, was observed under Frenzel's glasses along with head tilt to the left. The phenomenon could be elicited experimentally by right-ear stimulation with low-frequency noise (mean frequency, 125 Hz; 90 dB), as well as by constant pressure. The patient also reported observing the phenomenon with loud noises, nose blowing, obstruction of his right external meatus with the finger, and with altitude pressure changes in a car. This suggests that the phenomenon is elicited via the eardrum and the ossicular chain. Since lateral head tilt and counterrolling were tonic and without nystagmus, it is unlikely that one of the semicircular canals is involved as in usual Tullio cases. Rather, the otoliths may play a role in pathogenesis. Possible causative mechanisms are discussed along with the relevant literature.
一名44岁男性患者三年前遭受了听觉创伤，此后每当发元音u或e时，他就会出现眩晕以及周围环境向右倾斜的症状。在这种情况下，在弗伦泽尔眼镜下观察到，患者在发声过程中眼球持续向左强直性扭转，同时头部向左倾斜。通过右耳低频噪声刺激（平均频率125赫兹；90分贝）以及持续按压，能够诱发该现象。患者还报告称，在遇到大声噪音、擤鼻涕、用手指堵塞右外耳道以及乘车时海拔气压变化时，也会出现这种现象。这表明该现象是通过鼓膜和听骨链诱发的。由于头部向侧方倾斜和眼球反向转动是强直性的，且没有眼球震颤，因此不太可能像常见的图利奥病例那样涉及某一个半规管。相反，耳石可能在发病机制中起作用。本文结合相关文献讨论了可能的致病机制。
