Pierre Reynard

Background: Superior semicircular canal dehiscence (SSCD) is characterized by a bony defect of the superior semicircular canal (SSC), leading to vestibular and auditory symptoms. A process of spontaneous “auto-plugging,” in which the overlying dura mater progressively occludes the SSC, may replicate the effects of surgical canal plugging but remains under-recognized. The present study reports diverse clinical, instrumental, and 3d High Resolution MRI findings in patients with SSCD and subsequently confirmed to present with spontaneous complete or partial auto-plugging. Methods: We retrospectively reviewed 11 patients with SSCD diagnosed on high-resolution CT and suspected auto-plugging based on clinical atypia and large dehiscence (>4 mm). Patients underwent comprehensive neurotological assessment, including pure-tone audiometry, vestibular testing, and HR MRI with 3D labyrinthine reconstructions to identify partial or complete auto-plugging. Auto-plugging was classified as partial (Canalis semicircularis superior depressus) or complete (absence of endolymph fluid signal; Canalis semicircularis superior obturatus). Results: Among 13 ears with auto-plugging, 6 were partial and 7 complete. The mean SSCD size in auto-plugged ears was 5.5 mm. Most ears had normal or near-normal vestibular function on VHIT, with minimal air-bone gaps and preserved VEMP responses. Imaging demonstrated varying degrees of dural contact with the SSC, confirming partial or complete canal occlusion. Conclusions: Spontaneous auto-plugging of the SSC is a plausible, under-recognized phenomenon that may reproduce functional effects of surgical plugging. Dedicated 3D labyrinthine MRI enhances detection and characterization. Prospective multimodal studies are needed to clarify the pathophysiology, progression, and clinical implications, optimizing patient selection for surgical versus conservative management.

The vestibular atelectasis (VA) is a very rarely reported clinical and radiological condition characterized by the collapse of the labyrinthine membrane. Clinical features include symptoms which mimic endolymphatic hydrops; bilateral forms are rarely reported in the literature. Tullio’s sign was reported in a few cases. In this paper, we report an original case of bilateral fluctuating VA associated with a rare posterior semicircular canal (SSC) dehiscence variant. A 54-year-old patient presented with evolving and fluctuating bilateral vestibulopathy associated with a pressureinduced nystagmus. Vestibular assessment revealed a bilateral vestibulopathy affecting low and mid velocities, with fluctuating high-velocity impairment. Exploration of the otolithic system showed preserved saccular activity and an absence of utriculo-ocular response. Radiological evaluation demonstrated bilateral VA and a dehiscence of the right posterior SSC. We provide clinical elements to better understand this entity, and propose a new hypothesis for the presence of a previously reported Tullio sign in VA.Cite this article as: Reynard P, Damien M, Constant Ionescu E, Thai-Van H. Bilateral vestibular atelectasis as a fluctuating bilateral vestibulopathy: a case report care. J Int Adv Otol. 2025, 21(3), 1625, doi: 10.5152/iao.2025.241625.

Background/Objectives: As vestibular paroxysmia (VP) has recently been described in children, with an incidence of up to 4% of vertigo, and a promising therapeutic response to sodium-channel-blocking drugs has also been reported, the aim of this paper is to review the available literature on this topic and to provide the best possible guidance for diagnosis and treatment. Methods: PubMed, Medline, Cochrane, and Crossref databases were searched, and all studies on VP in children and sodium channel blockers were selected. Results: Only five articles reporting small case series or single case reports were identified. To date, oxcarbazepine (OXC) and carbamazepine (CBZ) are the only two molecules prescribed. The recommended doses were 300 to 360 mg/day and 50 to 200 mg/day for OXC and CBZ, respectively, for a total duration of 6 weeks. Fast efficacy (one week) was reported. Conclusions: VP has been identified in pediatric patients and appears to respond to sodium channel blockers in a manner similar to adults. Only a limited number of cases have been reported to date; thus, there is a need to raise awareness about this treatable cause of episodic vertigo in children.

Vestibular paroxysmia (VP) is a disabling medical condition characterized by a high recurrence rate of vertigo. VP is classically associated with the presence of contact between a vascular structure and the cochleovestibular nerve, a neurovascular cross compression (NVCC). Antiepileptic drugs are the first-line treatment for disabling symptoms. We conducted a systematic review to evaluate their efficacy in patients with VP, and whose imaging shows NVCC. All published studies in PubMed databases until October 2024 were included. A total of seven studies were selected. Carbamazepine and oxcarbazepine are by far the most widely used drugs, but there is still a lack of data showing the efficacy of antiepileptic drugs in a large sample of patients. This suggests that a future randomized controlled trial with a satisfactory sample size of VP patients with NVCC and comparing several drugs with neuroprotective properties is needed. Further, as imaging in some of the patients with obvious clinical signs does not always support this diagnosis, we discussed VP physiopathology and the different types of VP published in the literature, including those with no radiological support for NVCC.

Background/Objectives: Objective: To discuss therapeutic outcomes in patients with symptomatic near-narrow internal auditory canal (NNIAC). Methods: We retrospectively analyzed the records of 26 symptomatic patients diagnosed with NNIAC, who had been treated with anti-epileptic drugs. In addition to clinical and radiological data, we recorded I–III latencies of auditory brainstem responses prior to and after medical therapy. Results: Among a total of 48 patients with NNIAC, 26 patients were included. Oxcarbazepine, Gabapentin, and Lamotrigine were prescribed among 19 (73%) patients, 6 (23%) patients, and 1 patient (4%), respectively. After treatment, 24 (92.3%) patients described improvement of vestibular symptoms, and 16 (76.2%) reported improvement of auditory symptoms. After treatment with antiepileptic drugs, ipsilateral IPL I-III latencies decreased (less than 2.3 ms) in 16 (84.2%) patients (23 ears out of 42). Conclusions: A low dose of anti-epileptic monotherapy for NNIAC could be effective over the long term and is generally well-tolerated. Further studies are needed to provide more solid evidence of the efficacy and safety of anti-epileptic drugs on a larger number of patients with NNIAC.

Background/Objectives: Spontaneous nystagmus during vertigo attacks of Menière’s disease has been essentially described as horizontal, beating ipsilaterally (irritative type) or contralaterally (deficit type) to the hearing loss. Our main objective was to describe the characteristics of nystagmus during vertigo attacks. The second objective was to determine the feasibility of self-video recording of eye movements by a mobile phone. The third objective was to discuss the therapeutic implications of the observed nystagmus. Methods: We selected patients with definite Menière’s disease according to the Barany Society. Patients were video-recorded during their attacks by videonystagmoscopy (by the physician) and/or mobile phone (by the patient or immediate surroundings). Results: Seventeen patients were video-recorded by mobile phone (n = 8) or videonystagmoscopy (n = 8) or both (n = 1). The nystagmus was horizontal in 14 patients of the irritative type (n = 7) and of the deficit type (n = 5) or changed from the deficit to the irritative type (n = 2). The nystagmus was vertical in three patients, either down-beating (n = 2) or up-beating (n = 1). This vertical nystagmus changed to a more classical horizontal nystagmus in two patients. Conclusions: The direction of the nystagmus was variable and mostly horizontal, although it could be vertical and could change direction. Thus, the direction of the nystagmus has no value in deducing the affected side of Menière’s disease, which essentially relies on hearing dysfunction. The nystagmus could be video-recorded by a mobile phone, which was objective proof of the impact on daily life. This was a helpful therapeutic aid, particularly when chemical labyrinthectomy was considered.

We read, with great interest, two recent articles by Castellucci and al