A 58-year-old patient was referred to our department for autophony and resonance in the LE (heartbeat, footsteps, and eyeball and eyelid movement perception) and left pulsatile tinnitus. Audio-vestibular assessment revealed left conductive hearing loss (Figure 7A) and cVEMP with a very large amplitude and abnormally low bilateral thresholds (70 dB nHL on the RE and 60 dB nHL on the LE). The rest of the vestibular assessment was normal. CT scan showed a bilateral SSCD (Figures 7B-E), with an additional OCD between the VA and the IJV on the right non-symptomatic ear (Figures 7F, G). An SSCD plugging was performed by the middle fossa approach.
At 4 months, the pulsatile tinnitus had disappeared. Conductive hearing loss, autophony, and resonance symptoms in the LE improved. The cVEMPs normalized on the LE. The patient reported improvement in both autophony and pulsatile tinnitus but complained of a new but less severe tinnitus, probably due to high-frequency hearing loss (Figure 7H). MRI showed that the SSCD had been properly plugged (Figure 7I).