Three weeks after a diving injury with middle ear barotrauma, a 29-year-old man has fluctuating sensorineural hearing loss and vertigo that worsens on straining and nose blowing. Pneumatic otoscopy in the office reproduces vertigo and nystagmus. The finding elicited on pneumatic otoscopy is called:

• A Hennebert sign ✓
• B Tullio phenomenon
• C Dix-Hallpike response
• D Fistula sign of Bezold

Explanation

The Hennebert sign is the induction of vertigo and nystagmus by pressure changes in the external ear canal (pneumatic otoscopy or tragal pressure), seen when a perilymph fistula allows air pressure to displace the oval or round window membranes. The Tullio phenomenon is similar vertigo induced by loud sounds rather than pressure. In this post-barotrauma setting with Valsalva exacerbation, a perilymph fistula with a positive Hennebert sign is the classic combination.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.