Case Reports in Otolaryngology

Case Report

Diagnostic Bedside Vestibuloocular Reflex Evaluation in the Setting of a False Negative Fistula Test in Cholesteatoma of the Middle Ear

Table 1

Summary of findings for the three patients included in this study.


	Patient 1	Patient 2	Patient 3

Sex	Male	Male	Male

Age (years)	25	22	43

Diagnosis	Meningitis secondary to cholesteatoma	COM	COM

Ear affected	Left	Left	Right

Ear symptoms	Progressive hearing loss & Otorrhea	Progressive hearing loss & Otorrhea	Progressive hearing loss & Otorrhea

Clinical data	Meningitis	Acute vertigo; 1 week	No vertigo

Ear exam	Abundant otorrhea and cholesteatoma; no identification of middle ear structures. No vertigo on aspiration	Otorrhea and polyp filling the EAC	Otorrhea in the EAC; tympanic membrane perforation with cholesteatoma filling the middle ear

Audiometry	Right: normal	Right: normal	Right: moderate mixed hearing loss
Audiometry	Left: cophosis	Left: profound mixed hearing loss	Left: normal

Radiology	Chol & Left horizontal canal fistula & Tegmen tympani dehiscence	Chol & Left horizontal canal fistula	Chol & Right horizontal canal fistula

Fistula test	Negative	Negative	Negative

Spontaneous nystagmus	Negative	Rightward	Negative

cHIT	Left positive	Left positive	Right positive

vHIT	n.d.	Grh: 0.77; Glh: 0.15	Gra = 1.2; Grh = 0.27; Grp = 1.1; Gla = 1.2: Glh = 0.8; Glp = 1.2

COM: cholesteatomatous otitis media; EAC: external auditory canal; Chol: suspected cholesteatoma in CT scan; cHIT: bedside head-impulse test. Positive if refixation saccades are seen after head impulses to one or the other side; vHIT: video head-impulse test; Gra: gain of the VOR for head impulses in the plane of the right superior semicircular canal; Grh: gain of the VOR for rightward head impulses; Grp: gain of the VOR for head impulses in the plane of the right posterior semicircular canal; Gla: gain of the VOR for head impulses in the plane of the left superior semicircular canal; Gl: gain of the VOR for leftward head impulses; Glp: gain of the VOR for head impulses in the plane of the left posterior semicircular canal; n.d.: not done.