A patient with attic cholesteatoma undergoes surgery. The surgeon observes that the matrix of the cholesteatoma has extended medially to erode the bony labyrinth, creating a fistula of the horizontal semicircular canal. Clinically, this would manifest as a positive:

• A Hitselberger's sign
• B Hennebert's sign alone
• C Tullio phenomenon alone
• D Fistula test (positive pressure-induced nystagmus) ✓

Explanation

A labyrinthine fistula (most commonly of the horizontal/lateral semicircular canal) is detected clinically by the fistula test — applying positive or negative pressure to the external auditory canal via a pneumatic otoscope or Politzer bag deflects the perilymph through the fistula, exciting the semicircular canal ampulla and producing nystagmus toward the ipsilateral (affected) ear on positive pressure. This is a positive fistula test and indicates a labyrinthine fistula. Hennebert's sign (fistula test positive without demonstrable fistula) occurs in Meniere's disease due to utriculoendolymphatic adhesions. Hitselberger's sign is hypoesthesia of the posterior EAC due to acoustic neuroma.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.