PMC5366778_01
Case 1. Two different sections in the CT scan showing the fistula of the left horizontal semicircular canal and the middle ear filled with cholesteatoma and inflammatory tissue.
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A 25-year-old man presented to the emergency room with an intracranial complication secondary to the chronic otitis media as shown in a CT scan (Figure 1).
PMC5366778_02
Case 2. Video head impulse test of the patient. (a) Rightward head impulses in the plane of the horizontal canal (RHHI) induce a correct response in terms of the gain of the VOR; fast eye movements in the contrary direction of the eye after the reflexive eye movement are seen as part of the spontaneous nystagmus and imbalanced vestibular nuclei function in the acute stage. (b) Leftward head impulses in the plane of the horizontal canal (LHHI) do not evoke a correct eye response; gain is very low and is followed by refixation saccades mixed with the fast phases of the spontaneous nystagmus.
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With the vHIT we were able to record a very low gain for head impulses towards the affected side with covert and overt refixation saccades as a response to the vestibular deficit and because of the spontaneous nystagmus beating towards the normal ear as well as anticompensatory quick eye movements for head movements towards the nonaffected side (Figure 2).
PMC5366778_03
Case 3. Two different slices of the CT scan showing the fistula of the right horizontal semicircular canal and the middle ear filled with cholesteatoma and inflammatory tissue.
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fig3
In this case, we were able to demonstrate that the damage was restricted to the area of the fistula (Figure 3) in the horizontal canal (Figure 4).
Case 3. Video head impulse test of the 6 semicircular canals. R (right) and left (L) ears, superior (S), horizontal (H), and posterior (P) canals. In the case of the affected canal (RH) the normal eye response is substituted by covert refixation saccades.
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fig4
In this case, we were able to demonstrate that the damage was restricted to the area of the fistula (Figure 3) in the horizontal canal (Figure 4).