European Archives of Oto-Rhino-Laryngology
LETTER TO THE EDITOR
Autophony of eyelid movement is not independent of eyeball
Mahmood F. Bhutta
Received: 1 May 2018 / Accepted: 23 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Bertholon et al. recently described characteristics of autoph-
ony of eyeball or eyelid movement in six patients with supe-
rior semicircular canal dehiscence (SSCD) syndrome .
They conﬁrm my observation that autophony of eye move-
ments is speciﬁc to this syndrome , but also report the
novel ﬁnding of autophony of eyelid movement, which also
appears to be speciﬁc to this syndrome.
However, the authors fail to consider that eyelid move-
ment is not independent of eyeball movement. Several stud-
ies [3–5] show that the eyeballs invariably rotate downwards
and inwards with each blink, with this movement starting
just before the blink is initiated .
In the cohort of patients described by Bertholon et al.,
the majority described both autophony of eyeball and
autophony of eyelid movement, but, admittedly, there were
patients with only one of these symptoms. This could be
interpreted as signifying independent aetiology, but the par-
simonious explanation is that both these symptoms represent
diﬀering manifestations of autophony of eyeball movement.
Perhaps those individuals who describe only autophony of
eyelid movements do so because the downward and inward
movement accompanying a blink is an otherwise unusual
movement for the eyeball, and it is only when this speciﬁc
eyeball movement occurs that these patients experience the
Bertholon et al. admit that autophony of eyeball and eye-
lid movement is diﬃcult to explain. If, in fact, both these
symptoms relate to eyeball movement, then my theory of
direct transmission of extraocular muscle contraction to
movement of the dura overlying the superior semicircular
canal remains a valid and simple explanation .
Compliance with ethical standards
Conflict of interest Author MB declares that he has no conﬂict of in-
Ethical approval This article does not contain any studies with human
participants or animals performed by any of the authors.
1. Bertholon P, Reynard P, Lelonge Y, Peyron R, Vassal F, Karkas
A (2018) Hearing eyeball and/or eyelid movements on the side
of a unilateral superior semicircular canal dehiscence. Eur Arch
2. Bhutta MF (2015) Eye movement autophony in superior semicir-
cular canal dehiscence syndrome may be caused by trans-dural
transmission of extraocular muscle contraction. Int J Audiol
3. Bour LJ, Aramideh M, de Visser BW (2000) Neurophysiological
aspects of eye and eyelid movements during blinking in humans.
J Neurophysiol 83(1):166–176
4. Bergamin O, Bizzarri S, Straumann D (2002) Ocular torsion
during voluntary blinks in humans. Investig Ophthalmol Vis Sci
5. Rambold H, Sprenger A, Helmchen C (2002) Eﬀects of volun-
tary blinks on saccades, vergence eye movements, and saccade-
vergence interactions in humans. J Neurophysiol 88(3):1220–1233
This comment refers to the article available at https ://doi.
* Mahmood F. Bhutta
Department of ENT, Brighton & Sussex University
Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK