Abstract Background Eustachian tube dysfunction can occur due to head and neck tumors or as a consequence of radiotherapy; however, audiological changes linked to head position are rarely reported. In this paper, we present a unique case exhibiting positional audiological findings. Clinical observations are detailed, and the literature is reviewed. Probable mechanisms are discussed, potentially offering valuable insights for clinical evaluations. Case presentation A 46-year-old patient was referred for a painful lesion on the hard palate. Imaging and histopathological analysis confirmed an adenoid cystic carcinoma with posterior extension into the soft palate and focal bone erosion. The patient underwent surgical excision followed by radiotherapy. Six months post-treatment, he developed otologic symptoms—including autophony, tinnitus, vertigo, and fluctuating hearing—exacerbated by turning his head toward the side of the lesion. Audiometry and tympanometry revealed a fluctuating air–bone gap and positional changes in tympanogram type in the right ear (Type B tympanogram in the straight position; Type C when the head was turned to the right and slightly downward). These symptoms resolved spontaneously over 20 days. At the 12-month follow-up, audiometric results had normalized, but tympanometry continued to show Type C pattern in both positions, despite the absence of associated symptoms. Conclusion This case illustrates a rare instance of head position-dependent variations in audiologic test results in a post-radiotherapy patient with adenoid cystic carcinoma, which may related to transient Eustachian tube dysfunction or dysfunction of the tensor veli palatini muscle. To our knowledge, this is the first report demonstrating immediate positional effects on both audiometry and tympanometry. These findings highlight the potential value of conducting audiological assessments in different head positions in selected head and neck pathologies and emphasize the need for further diagnostic evaluations.
Kari et al. (Sat,) studied this question.