The Tullio effect in a patient qualified for cochlear implantation: Diagnosis, management and rehabilitation performance: A case report

A case study on the qualification and treatment of profound hearing loss with a cochlear implant in a patient with a positive Tullio effect is described. To our knowledge this is the first such case reported in the literature. PATIENT CONCERNS: A 46-year-old woman was admitted due to sudden hearing loss in the right ear (RE). The patient had suffered from bilateral hearing loss since childhood and was fitted with hearing aids on the RE successfully, in contrast to the left ear. While undergoing pure-tone audiometry, a positive Tullio effect was observed in the RE. The average hearing threshold for the RE was 95 dB. Due to the lack of effective treatment for sudden hearing loss, the patient was qualified for cochlear implantation. The patient’s attempts to place a hearing aid on the RE resulted in dizziness. DIAGNOSES: Computed tomography excluded the presence of a perilymphatic fistula, which could have been the cause of the patient’s vertigo. INTERVENTIONS: During the surgical procedure of cochlear implantation, considering the possible mechanisms of the Tullio effect, the incus was removed and the niche of the oval window was filled with fragments of connective tissue. The postoperative course was uneventful. OUTCOMES: Three months after implantation, speech intelligibility in the free field was 80% of the correctly repeated elements of the numerical test, at 65 dB sound pressure level. An acoustic stimulation test was performed during tonal audiometry and no preexisting symptoms were observed. LESSONS: A positive Tullio effect does not contraindicate treating hearing loss by means of cochlear implantation. When the Tullio effect is present, it is necessary to exclude presence of perilymphatic fistula. During cochlear implant surgery, in a patient with a positive Tullio effect, it is reasonable to disconnect the ossicular chain with the simultaneous sealing of the oval window niche.