--- title: "Tullio Phenomenon & Hennebert's Sign | Sound and Pressure Induced Vertigo" description: "ENT notes on Tullio Phenomenon and Hennebert's Sign." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tullio-phenomenon-hennebert-sign" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Otology"] video: "https://www.youtube.com/watch?v=IQHaMsPqqQ8" image: "https://media.theentresident.com/og-images/tullio-phenomenon-hennebert-sign.png" --- # Tullio Phenomenon & Hennebert's Sign | Sound and Pressure Induced Vertigo ENT notes on Tullio Phenomenon and Hennebert's Sign. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=IQHaMsPqqQ8 ## Tullio Phenomenon & Hennebert's Sign Two classical signs of **vertigo induced by external stimuli** are seen in otology. In this post, we will discuss: * Tullio Phenomenon, which is **sound induced** vertigo * Hennebert's Sign, which is **pressure induced** vertigo --- ### Tullio Phenomenon #### 📌 Type of Sign 👉 Clinical Sign elicited by **Sound stimulation**. #### 🔍 What is the Sign? Tullio Phenomenon refers to **vertigo and nystagmus induced by loud sounds**. #### Seen In 1- **Superior Semicircular Canal Dehiscence** (Classical association) 2- Perilymph fistula 3- Meniere's disease (very rarely) 4- Cholesteatoma with labyrinthine fistula 5- Congenital syphilis #### Features * Vertigo * Nystagmus * Imbalance * Nausea #### 🧠 Why Does it Occur? Normally, sound stimulates only the **cochlea**. In Tullio phenomenon, loud sound stimulates the **cochlea and the vestibular system**, producing vertigo and nystagmus. #### ⭐ The Third Window Effect The key concept underlying Tullio phenomenon. > What is the third window effect? Describe it. #### 👨‍⚕️ Eponym Named after Pietro Tullio, who described sound induced vestibular responses in experimental animals. > What are the features of superior semicircular canal dehiscence? --- ### Hennebert's Sign #### 📌 Type of Sign 👉 Clinical Sign elicited during **Vestibular examination**. #### 🔍 What is the Sign? Hennebert's Sign refers to **vertigo and nystagmus produced by pressure changes in the external auditory canal, in the absence of a true labyrinthine fistula**. ⭐ It is essentially a **false positive fistula test**. #### 🩺 How is it Elicited? Pressure in the external auditory canal is changed by: * Pressing the tragus * Using **Siegel's speculum** #### Seen In 1- **Congenital syphilis** (Classical example), due to a **hypermobile stapes footplate** 2- **Meniere's disease**, due to a fibrous band connecting the utricle to the macula 3- **Superior semicircular canal dehiscence** #### 🧠 Why Does it Occur? Normally, the fistula test is positive only when there is an **abnormal opening between the middle ear and inner ear**. In Hennebert's sign, there is **no true bony fistula**, but pressure is **transmitted abnormally to the vestibular system** due to an underlying pathology of the labyrinth. #### 👨‍⚕️ Eponym Named after Hennebert, who described this positive fistula-like response without an actual fistula, especially in congenital syphilis. > Name the condition where you see a True positive fistula test. > Name the conditions where you see a False negative fistula test. --- ### ⭐ High Yield Rapid Revision Table | Feature | Tullio Phenomenon | Hennebert's Sign | | --- | --- | --- | | Stimulus | Loud sound | Pressure change in the external auditory canal | | Finding | Vertigo and nystagmus | Vertigo and nystagmus | | Classical Condition | Superior semicircular canal dehiscence | Congenital syphilis | | Mechanism | Third window effect | Abnormal transmission of pressure to the vestibular system without a true fistula | --- ### 🧠 Viva Pearls * Tullio phenomenon is vertigo and nystagmus induced by loud sounds. * Tullio phenomenon is classically described in superior semicircular canal dehiscence. * Tullio phenomenon is also seen in perilymph fistula, Meniere's disease, cholesteatoma with labyrinthine fistula and congenital syphilis. * The third window effect is the key concept in Tullio phenomenon. * Hennebert's sign is vertigo and nystagmus on pressure change in the external auditory canal, without a true labyrinthine fistula. * Hennebert's sign is a false positive fistula test. * Hennebert's sign is classically seen in congenital syphilis, due to a hypermobile stapes footplate. * In Meniere's disease, Hennebert's sign is due to a fibrous band connecting the utricle to the macula. --- ## About This Note This free ENT note on Tullio Phenomenon & Hennebert's Sign | Sound and Pressure Induced Vertigo was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tullio-phenomenon-hennebert-sign When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Signs, Syndromes, Triads, and Compilation Lists in ENT: https://www.theentresident.com/ent-notes-lectures/category/signs-syndromes-triads-lists-in-ent.md - Otology: https://www.theentresident.com/ent-notes-lectures/category/otology.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md ## Medical-use Boundary The ENT Resident provides educational material for medical learning and revision. 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