Video 6.11 Nystagmus in superior canal dehiscence syndrome (SCDS) provoked by pinched-nose Valsalva from Neuro-Ophthalmology and Neuro-Otology Textbook

: This is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (towards the right ear) nystagmus, suggestive of excitation of the right anterior canal (slow phase down and torsion towards left ear, with position reset/fast phase in the opposite directions). There was more downbeat nystagmus in right gaze, and more torsional (towards right ear) nystagmus in left gaze. Superior canal dehiscence (SCD) was demonstrated on the right side on CT temporal bones and SCD syndrome was diagnosed. Valsalva and pinched-nose/nasal Valsalva maneuvers should be performed when there is a suspicion for SCDS (noise/pressure triggers, autophony + vertigo attacks, etc). - - : This patient complained of autophony (e.g., hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (toward the right ear) nystagmus, suggestive of excitation of the right anterior canal (slow phase down and torsion toward left ear, with position reset/fast phase in the opposite directions). There was more downbeat nystagmus in right gaze, and more torsional (toward right ear) nystagmus in left gaze. Superior canal dehiscence (SCD) was demonstrated on the right side on CT temporal bones and SCD syndrome was diagnosed. Valsalva and pinched-nose/nasal Valsalva maneuvers should be performed when there is a suspicion for SCDS (noise/pressure triggers, autophony + vertigo attacks, etc.) https://collections.lib.utah.edu/details?id=1213443, https://collections.lib.utah.edu/ark:/87278/s6md2nwh. (Video courtesy of Dr. John Carey