Pressure-Induced Ocular Torsion

We describe 3 patients within whom ocular torsion could be induced by application of positive air pressure to one external ear canal. In all cases, the superior pole of the eye rotated away from the stimulated ear when positive pressure was applied. The amplitude of torsion ranged from 3 degrees to 16 degrees. Exploratory tympanotomy was performed in all 3 patients. In 2 patients, round-window fistulas were found and repaired. In the third patient, no fistula was noted but the oval- and round-window areas were patched. There was no resolution of symptoms after surgery in any patient. Based on these cases, patients presenting with pressure-induced ocular torsion are unlikely to have resolution of their symptoms, even when a perilymphatic fistula is confirmed and repaired. We hypothesize that pressure-induced ocular torsion is caused by an irreversible juxtaposition of the utricle and stapes footplate.