Hennebert sign is vertigo or nystagmus elicited by pressure changes in the external auditory canal. Which condition is most commonly associated?

• A. Meniere disease
• B. Acoustic neuroma
• C. Otosclerosis
• D. Perilymph fistula or superior canal dehiscence

Answer: (D)

Hennebert sign shows how the labyrinth responds to changes in pressure transmitted through the middle ear. When you apply pressure in the external auditory canal, a normal ear should not cause vertigo or eye movements, but if there’s a leak or a third window abnormality, that pressure can move the inner-ear fluids abnormally and trigger vertigo or nystagmus.

This sign is classically seen with disorders that disrupt the integrity of the inner ear or its bony cover, allowing middle-ear pressure to affect the vestibular system. Perilymph fistula involves a leak around the oval or round window, so even small pressure changes can provoke vertigo. Superior canal dehiscence creates a “third window” in the vestibular apparatus, making the canal hypersensitive to pressure and sound, also causing vertigo with pressure changes.

Among the options, those other conditions don’t typically produce vertigo or nystagmus just from ear-pressure changes: Meniere disease involves fluctuating endolymphatic hydrops with episodic vertigo but isn’t driven by pressure in the ear; acoustic neuroma and otosclerosis affect vestibular function or middle-ear mechanics in different ways and don’t classically give a positive Hennebert sign. Thus, the sign is most commonly associated with a perilymph fistula or superior canal dehiscence.