A 73-year-old woman referred to our center for a follow-up evaluation of right-sided canal wall down (CWD) mastoidectomy due to a COM with cholesteatoma. The surgical procedure was conducted two years earlier without simultaneous functional stage. She experienced symptoms consistent with right-sided cochleo-vestibular loss following surgery. Pressure-induced unsteadiness and dizziness represented her prominent residual vestibular symptoms. Otoscopy highlighted dry right EAC and well-preserved postoperative conditions. Her audiogram showed right-sided mixed HL with widened air-bone gap at lower frequencies and contralateral age-related sensorineural HL (). Although spontaneous nystagmus could not be observed with video-Frenzel goggles, mastoid vibrations elicited left-beating nystagmus. Horizontal nystagmus directed toward the affected side was evoked applying positive pressure on her right EAC, reversing on removal of the pressure. Conversely, no nystagmus could be noticed with Valsalva maneuvers. Even though she denied positional vertigo, left-beating nystagmus could be observed on supine positioning and slightly persistent geotropic direction-changing nystagmus was elicited after head rolls, with stronger amplitude on right-sided positioning (). vHIT measurements were taken on the same day, showing VOR-gain reduction for all SCs of the right side and mildly impaired function for left PSC (). High-resolution CT scan detected postoperative LF involving right HSC without inflammatory recurrences (). Although we proposed revision surgery for LF closure and hearing restoration, she refused additional procedures as audio-vestibular symptoms did not prevent her from leading a normal life.
Patient 1. A 25-year-old man presented to the emergency room with an intracranial complication secondary to the chronic otitis media as shown in a CT scan (). He was diagnosed and treated when neurologically stable. In this case the vestibular damage has occurred progressively over many years and as such was successfully compensated. The affected ear was the left; the fistula sign was negative (no nystagmus under rubber bulb applied pressure to the external ear) but the bedside head impulse test was positive due to the appearance of intense refixation saccades that indicated a major vestibular deficit.