Middle Ear Implant Triggers Vertigo with Swallowing and Burping, Rare Case Shows

For most people, a burp or a swallow passes unnoticed. For a 54-year-old woman, however, either action triggered a brief but intense spell of vertigo—a condition that began roughly six months after she received a tiny prosthesis in her right middle ear.

The case was presented as a poster at the American Academy of Audiology’s AAA 2026 convention in San Antonio. In the abstract, clinicians from the Ear Institute at New York Eye and Ear Infirmary of Mount Sinai detail how they traced the patient’s dizziness to a leak in her inner ear, ultimately referring her for implant removal. Once surgeons extracted the device, her vestibular symptoms resolved completely.

The poster, titled “Positive Fistula Response and Pressure-Evoked Dizziness After Middle-Ear Surgery: Audiologic and Vestibular Findings,” was led by audiologist Katherine Scigliano, AuD, with co-authors Rebecca Sherman, AuD, Maura Cosetti, MD, and Jenifer Kelly, DPT. The authors note that post-surgical vertigo linked to a third-window effect is rarely documented, and they found no prior case reports describing this exact symptom profile. As a single-patient conference abstract, the published details remain limited.

A Partial Ossicular Prosthesis and an Unusual Trigger

The device was a partial ossicular replacement prosthesis (PORP). Surgeons use these small implants to reconstruct a segment of the ossicular chain—the tiny bones that transmit sound from the eardrum to the inner ear. As illustrated in Stanford’s otologic surgery atlas, a PORP typically bridges the eardrum to the stapes (the final bone in the chain), often with a thin cartilage graft placed between the implant and the eardrum to prevent extrusion.

The abstract does not specify the indication for the original surgery. It does report that six months post-operatively, the patient developed “pressure-induced vertigo,” with episodes specifically “triggered by burping and swallowing.” The authors characterize these spells as transient.

These triggers are physiologically coherent. As Stanford Medicine’s ear institute explains, the Eustachian tube opens during swallowing or yawning to equalize middle-ear pressure. In this patient, testing indicated that minute pressure fluctuations from these routine actions were reaching the balance system.

Eye Movements Pointed to the Right Ear

Suspecting a third-window effect, clinicians ordered vestibular testing. The team performed videonystagmography (VNG), which records nystagmus—involuntary eye movements driven by the inner ear’s balance organs. Abnormal eye movements can reveal inappropriate stimulation of these organs.

Most results were unremarkable; oculomotor, gaze, and positional testing fell within normal limits. The exception was the fistula test, during which clinicians vary air pressure in the ear canal while monitoring eye movements.

The right ear elicited a positive response, showing “direction-changing nystagmus with both positive and negative pressure,” a finding the authors deemed “consistent with third window physiology.” Positive pressure drove the eyes toward the right ear; negative pressure reversed the beating direction to the left. The left ear tested normally. Clinicians also recorded VNG goggles during swallowing, which produced no nystagmus, and during tragus palpation, which yielded an inconsistent left-beating nystagmus.

The Inner Ear’s Extra Opening Problem

A healthy inner ear possesses two compliant openings—the oval and round windows—that allow pressure waves to propagate through the cochlear fluids in a controlled manner. A “third window” is any pathological dehiscence or opening that permits pressure to escape the sealed system.

Researchers from Johns Hopkins and Stanford described this mechanism in a 2017 Frontiers in Neurology review on superior canal dehiscence, a well-characterized third-window disorder. In such cases, pressure that should traverse the cochlea diverts into the vestibular canals, provoking vertigo and nystagmus in response to loud sounds, Valsalva maneuvers, or external ear-canal pressure.

In this patient, the authors wrote, “The clinical presentation mirrors third-window physiology, suggesting a positive fistula-type response.” Based on these findings, she was diagnosed with a perilymphatic fistula—an abnormal communication between the fluid-filled inner ear and the air-filled middle ear—and referred back to her otologist. The abstract does not detail intraoperative findings during the removal procedure, so the precise mechanical interaction between the prosthesis and the inner ear remains unconfirmed.

A StatPearls review on the NCBI Bookshelf (updated August 2025) identifies ear surgery as a known cause of perilymphatic fistula, citing an incidence of roughly 1% following stapes procedures. It lists prosthesis malposition or late migration among the implicated etiologies. The review also highlights the fistula test—pressure-induced nystagmus—as a classic diagnostic indicator, while noting that labyrinthine fistulas remain rare and diagnostically controversial, lacking international consensus criteria.

Dizziness Resolved, Hearing Loss Persisted

The woman underwent what the authors termed a “successful PORP removal,” and her vestibular symptoms abated. The trade-off was auditory: the abstract states that “she continues to have a conductive hearing loss,” the type resulting from impaired sound transmission through the outer or middle ear.

The authors’ clinical takeaway emphasizes vigilance: “This case illustrates the need for comprehensive diagnostic management of post operative middle ear surgical patients.” In practice, this means a patient presenting months after ear surgery with pressure-sensitive dizziness warrants targeted vestibular evaluation, not merely a hearing assessment.

Several questions remain unanswered. The abstract does not report imaging findings, the original surgical indication, the prosthesis material, or the duration of follow-up. As a single case report, it cannot establish the incidence of this complication following PORP placement.

Clinicians advise that anyone experiencing dizziness, vertigo, or new hearing changes after ear surgery—particularly symptoms provoked by swallowing, straining, nose-blowing, or loud sounds—should promptly notify their surgeon or audiologist for appropriate evaluation.

Key Questions Answered

What happened to the patient in this case?

Six months after receiving a partial ossicular replacement prosthesis in her right ear, a 54-year-old woman developed brief vertigo spells triggered by burping or swallowing. She was diagnosed with a perilymphatic fistula, and removal of the prosthesis resolved the dizziness.

Why would burping or swallowing cause vertigo?

Swallowing opens the Eustachian tube, momentarily altering middle-ear pressure; burping generates a similar pressure shift. Testing suggested the patient’s inner ear was abnormally sensitive to these fluctuations, a pattern consistent with third-window physiology.

What is a fistula test?

During a fistula test, clinicians vary air pressure in the external ear canal while recording eye movements via VNG. If pressure changes provoke nystagmus, the test is positive, indicating that pressure is reaching the vestibular system through an abnormal pathway.

Did removing the prosthesis fix everything?

No. While her vestibular symptoms resolved, the patient retained a conductive hearing loss, according to the abstract.

Is this a common complication of middle-ear surgery?

This is a single case report and cannot determine frequency. The authors state that post-operative vertigo tied to a third-window effect is rarely reported, and medical reviews classify labyrinthine fistulas as rare, though ear surgery is a recognized risk factor.

Has this case been published in a medical journal?

As of the source date, the case has not appeared in a peer-reviewed journal. It was presented as a poster abstract at the AAA 2026 convention.

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