A 15-year-old with CSOM (atticoantral type) presents with a positive Hennebert sign: nystagmus and vertigo induced by tragal pressure or pneumatic otoscopy, with no evidence of a labyrinthine fistula on CT. The most likely explanation for this sign is:
- A A bony dehiscence of the lateral semicircular canal too small to be seen on CT
- B A fibrous connection between the cholesteatoma and the stapes footplate ✓
- C Autoimmune inner ear disease
- D Suppurative labyrinthitis
Correct answer: B. A fibrous connection between the cholesteatoma and the stapes footplate
Explanation
The Hennebert sign is a positive fistula test without a demonstrable labyrinthine fistula on imaging. It occurs when cholesteatoma or inflammatory tissue forms a fibrous adhesion to the stapes footplate, allowing pressure transmission to the inner ear without a bony dehiscence. This is distinct from a true fistula (which shows bony erosion on CT) and is an indication for surgery.
Reference: Diseases of the Ear, 6th, by Adam and Jackler ed.
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Written and medically reviewed by the StethoPrep medical team.