Departments: Letters to the Editor
Dr. Michael Rensink's Through the Otoscope column focused on the eardrum tissue hardening in a patient with tympanosclerosis. (“The Mysterious Tympanosclerosis.” HJ 2012;65:6; http://bit.ly/Tympanosclerosis.)
How would this affect the outcome of a caloric irrigation? If the wall has thickened, would the nystagmus from the irrigation be reduced, possibly causing a false positive for unilateral weakness?
Dr. Rensink responds: The presence of tympanosclerosis similar to our photograph wouldn't increase or decrease the caloric response on an electronystagmography. Tympanosclerosis thick enough to obliterate the tympanic membrane and possibly the middle ear is fortunately very rare. I haven't found any references in the electronystagmography literature that address this specific question, and I'm not sure whether the amount of tympanosclerosis would increase the response or decrease it because the solid material may be less of an insulator than air.