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Moneir W, Darwish AY, Khafagy YW, Youssef MA, El Rakhawy MM, Hemdan A. Superior semicircular canal dehiscence: a radiological and clinical study. Indian J Otolaryngol Head Neck Surg 2024; 76:865-870. [PMID: 38440643 PMCID: PMC10908998 DOI: 10.1007/s12070-023-04299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 03/06/2024] Open
Abstract
Aim to assess radiologically the prevalence of SSCD with its clinical presentations and its relationship with age. Methods a prospective cohort study carried out on 200 consecutive patients (400 temporal bones). Radiological evaluation was performed using High Resolution Computed Tomography (HRCT) with measurement of thickness of bone covering superior semicircular canal (SCC), height and diameter of SSC. Results Two hundred patients (400 temporal bones) were involved. The mean thickness ± SD, the mean diameter ± SD and the mean height ± SD were 1.38 ± 0.80 mm, 0.94 ± 0.26 mm and 10.91 ± 2.39 mm respectively. The prevalence of SSCD and predehiscence were 1% and 14% respectively. The commonest symptom encountered was autophony (48.3%). When the SSC thickness, diameter and height were compared with the age of patients, statistically significant differences were detected. The highest diameter, lowest height and lowest thickness were found in patients aged from 54 to 72 years. Thickness of bony layer covering SSC was found to be the most validated measurement for differentiation between cases with positive and negative symptoms with the highest sensitivity and specificity. Conclusion The prevalence of SSCD and predehiscence varied among the studies. Autophony is the commonest symptom usually encountered. The condition is acquired rather than congenital. The thickness of bone covering SCC is the most validated measurement in differentiation between cases with positive and negative symptoms.
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Affiliation(s)
| | | | | | | | - Mohammed Magdy El Rakhawy
- Mansoura Faculty of Medicine, Mansoura, Egypt
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Hemdan
- Lecturer of Otorhinolaryngology, Mansoura Faculty of Medicine, Mansoura, Egypt
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-gomhoria Street, Mansoura, Egypt
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Evaluation of Superior Semicircular Canal Morphology and Its Relationship with Glenoid Fossa Roof Thickness Using Cone Beam Computed Tomography. Radiol Res Pract 2022; 2022:1565038. [PMID: 36573139 PMCID: PMC9789904 DOI: 10.1155/2022/1565038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to evaluate the bone thickness of the superior semicircular canal (SSC) roof and its relationship with the roof thickness of the glenoid fossa (RGF). Methods The cone beam computed tomography (CBCT) images of 280 patients (560 temporal regions) were surveyed. The lowest thickness of the SSC roof was measured and categorized based on the radiological patterns of the Cisneros et al. classification. The thickness of GF and the presence of dehiscence in this part were determined, as well. The relationship between the thickness of the GF roof and the bone thickness covering the SSC was also assessed. Results The mean thickness of the SSC roof was 0.93 ± 0.48 mm, with no significant difference among different age groups and genders (p > 0.05). However, superior semicircular canal dehiscence (SSCD) was more prevalent among females over 45 years old. Similarly, the individuals with the dehiscence of the GF roof had a 12.93-fold higher chance of SSCD development. Conclusions The results indicated that the thickness of the bone overlying the SSC was significantly related to the roof thickness of the GF. However, an increase in age resulted in no significant change in the bone thickness of the SSC roof. Gender also had no role in changing the thickness of the bone overlying the SSC. Considering the decrease in the thickness of the SSC roof among females over 45 years of age, menopause may be responsible for this occurrence as well as for the increase in the prevalence of SSCD.
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Evlice B, Çabuk DS, Duyan H. The evaluation of superior semicircular canal bone thickness and radiological patterns in relation to age and gender. Surg Radiol Anat 2021; 43:1839-1844. [PMID: 34241668 DOI: 10.1007/s00276-021-02797-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aims to evaluate the superior semicircular canal (SSC) bone thickness and radiological patterns in relation to age and gender in a Turkish population using cone beam computed tomography (CBCT). METHODS A total of 450 temporal bones were evaluated in the study by two examiners. The radiological patterns of SSC were categorized as follows: dehiscent, papyraceous, normal, thick and pneumatised patterns. The bone thickness of SSCs were measured. RESULTS The mean bone thickness of the SSC for females was 1.079 ± 0.8 mm. For males, the mean bone thickness was 0.952 ± 0.6 mm. There was no significant difference between males and females for the mean bone thickness of the SSC. (p > 0.05) The normal pattern was found in 258 temporal bones (57.3%). Seventy-two cases (16%) were defined as "papyraceous pattern"; 23 cases (5.1%) were defined as "thick pattern" and 42 cases (9.3%) were defined as "pneumatised pattern". SSC dehiscence was determined in 55 cases (12.2%). There was no significant difference between radiological patterns for age groups and gender (p > 0.05). CONCLUSION There was no significant relationship between SSC bone thickness with age and gender. The radiological patterns of SSC were not associated with age and gender. Radiologists evaluating the head and neck region for various reasons should be aware of these structures and report not only the SSC dehiscence but also the papyraceous pattern.
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Affiliation(s)
- Burcu Evlice
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey
| | - Damla Soydan Çabuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey.
| | - Hazal Duyan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey
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Aladham Y, Ahmed O, Hassan SAS, Francis-Khoury E. Traumatic superior semicircular canal dehiscence syndrome: case report and literature review. J Surg Case Rep 2021; 2021:rjaa592. [PMID: 33532052 PMCID: PMC7837340 DOI: 10.1093/jscr/rjaa592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 11/14/2022] Open
Abstract
Superior semicircular canal dehiscence (SSCD) syndrome was first reported in 1998 by Minor et al. and comprises a spectrum of auditory and vestibular symptoms as a result of 'mobile third window' mechanism. The aetiology of SSCD is debated, but persistent infantile microstructure of the temporal bone was suggested. However, some authors related a 'second event', such as closed head trauma, temporal bone fracture and sudden increase in the intracranial pressure to the precipitation of its symptoms. In this article, we report a patient with a closed head trauma who developed unilateral auditory symptoms. High-resolution computed tomography images were obtained and confirmed bilateral SSCD with the normal middle ear structure. The patient was provided with a monaural hearing aid. Literature was searched for similar case reports or series where head trauma precipitated the symptoms of SSCD in anatomically susceptible individuals.
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Affiliation(s)
- Youssef Aladham
- Department of Otolaryngology and Head and Neck Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Omar Ahmed
- Department of Otolaryngology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | | | - Elias Francis-Khoury
- Department of Otolaryngology and Head and Neck Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
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Examination of the possible relation of the superior semicircular canal morphology with the roof thickness of the glenoid fossa and bone changes of the temporomandibular joint. Eur Arch Otorhinolaryngol 2020; 277:3423-3430. [DOI: 10.1007/s00405-020-06063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
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Dasgupta S, Ratnayake S, Crunkhorn R, Iqbal J, Strachan L, Avula S. Audiovestibular Quantification in Rare Third Window Disorders in Children. Front Neurol 2020; 11:954. [PMID: 33041966 PMCID: PMC7526203 DOI: 10.3389/fneur.2020.00954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
Third window disorders are structural abnormalities in the bony otic capsule that establish a connection between the middle/inner ear or the inner ear/cranial cavity. Investigated extensively in adults, they have hardly been studied in children. This study is a retrospective study of children (aged 5-17 years) diagnosed with rare third window disorders (third window disorders reported rarely or not reported in children) in a tertiary pediatric vestibular unit in the United Kingdom. It aimed to investigate audiovestibular function in these children. Final diagnosis was achieved by high resolution CT scan of the temporal bones. Of 920 children attending for audiovestibular assessment over a 42 month period, rare third windows were observed in 8 (<1%). These included posterior semicircular canal dehiscence (n = 3, 0.3%), posterior semicircular canal thinning (n = 2, 0.2%), X linked gusher (n = 2, 0.2%), and a combination of dilated internal auditory meatus/irregular cochlear partition/deficient facial nerve canal (n = 1, 0.1%). The majority of them (87.5%) demonstrated a mixed/conductive hearing loss with an air-bone gap in the presence of normal tympanometry (100%). Transient otoacoustic emissions were absent with a simultaneous cochlear pathology in 50% of the cohort. Features of disequilibrium were observed in 75% and about a third showed deranged vestibular function tests. Video head impulse test abnormalities were detected in 50% localizing to the side of the lesion. Cervical vestibular evoked myogenic potential test abnormalities were observed in all children in the cohort undergoing the test where low thresholds and high amplitudes classically found in third window disorders localized to the side of the defects in 28.5%. In the series, 71.4% also demonstrated absent responses/amplitude asymmetry, some of which did not localize to the ipsilesional side. Two children presented with typical third window symptoms. This study observes 2 new rare pediatric third window phenotypes and the presence of a cochlear hearing loss in these disorders. It emphasizes that these disorders should be considered as an etiology of hearing loss/disequilibrium in children. It also suggests that pediatric third window disorders may not present with classical third window features and are variable in their presentations/audiovestibular functions.
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Affiliation(s)
- Soumit Dasgupta
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sudhira Ratnayake
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Rosa Crunkhorn
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Javed Iqbal
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Strachan
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Shivaram Avula
- Department of Paediatric Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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Thinning or dehiscence of bone in structures of the middle cranial fossa floor in superior semicircular canal dehiscence. J Clin Neurosci 2020; 74:104-108. [PMID: 32044131 DOI: 10.1016/j.jocn.2020.01.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder; currently, it is unknown whether the etiopathology underlying this structural irregularity affects neighboring structures. The goal is to investigate the prevalence of bone thinning in areas of the middle cranial fossa (MCF) floor in SSCD and non-SSCD patients. METHODS This retrospective study analyzed 100 patients from March 2011 to June 2017 at a tertiary referral center. 100 patients undergoing 118 SSCD repair surgeries (18 bilateral) were identified. 12 SSCD ears were excluded due to lack of pre-operative computed tomography (CT) scans or history of prior SSCD repair at an outside facility. Non-SSCD ears were identified from routinely-obtained CT scans for temporal bone fracture (fractured sides excluded) for a total of 101 ears; 26 non-SSCD ears were excluded due to lack of high-resolution imaging. RESULTS Univariate analyses reveal that SSCD diagnosis is associated with higher rates of geniculate ganglion (GG) dehiscence compared with non-SSCD controls (42.7 vs. 24%; χ2(1) = 9.69,P = 0.008). Individuals with SSCD depicted significantly thinner bone overlying the geniculate ganglion (GG) (0.23 ± 1.2 mm) compared to controls (0.28 ± 1.8 mm, (t(1 6 4)) = 2.1, P = 0.04). SSCD patients presented thinner bone overlying the internal auditory canal (IAC) (0.33 ± 1.3 mm) compared to patients without SSCD (0.46 ± 1.6 mm, (t(2 5 7) = 6.4, P < 0.001). CONCLUSIONS The increased prevalence of dehiscence of the MCF in this cohort of SSCD patients compared to non-SSCD patients suggests that the etiology underlying SSCD affects surrounding structures.
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Children with posterior semicircular canal dehiscence: A case series. Int J Pediatr Otorhinolaryngol 2019; 123:51-56. [PMID: 31071598 DOI: 10.1016/j.ijporl.2019.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/23/2022]
Abstract
Posterior semicircular canal dehiscence is a rare condition and can cause a variety of symptoms. We report three cases of children between 5 and 12 years of age with a PSCD. They all presented with different complaints as follows: Tullio phenomenon in the first case, conductive hearing loss in the second and, conductive hearing loss and pulsatile tinnitus in the third. Imaging showed in all cases a PSCD on the right side, caused by a prominent jugular bulb (high riding bulb). We describe the clinical, audiometric and radiological findings, and discuss the management and therapy. A conservative "wait and see" approach is recommended, especially with children, because of the possible complications of surgery and the possibility that the symptoms will lessen with the skull base osseous maturation.
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Dasgupta S, Ratnayake SAB. Functional and Objective Audiovestibular Evaluation of Children With Apparent Semicircular Canal Dehiscence-A Case Series in a Pediatric Vestibular Center. Front Neurol 2019; 10:306. [PMID: 31001191 PMCID: PMC6454049 DOI: 10.3389/fneur.2019.00306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Abstract
Semicircular canal dehiscence is a bony abnormality in the otic capsule especially involving the superior semicircular canal. Since its identification in 1998, there is significant research regarding the pathology in the adult population. This condition generates a third window effect that is well–described in the literature. However, the entity is rare in the pediatric population with limited research. Difficulties encountered in children are obtaining a direct history that is essential for the diagnosis followed by neurovestibular tests that may be difficult to perform. This study presents observations regarding different clinical and diagnostic aspects of semicircular canal dehiscences in children as a retrospective audit in a tertiary pediatric vestibular center. Of 580 children assessed in a 30 months period undergoing comprehensive functional and objective audiovestibular assessment, 13 children (2.2%) were detected to possess radiological semicircular canal dehiscences (high resolution computed tomography scans at 0.625 mm slices reformatted in the axial, coronal and sagittal planes). The right superior semicircular canal was most commonly affected (66.6%). There were 4 bilateral semicircular canal dehiscences. Clinical suspicion of the condition was raised with reliable surrogate history from carers or from older children (100%), a mixed or conductive hearing loss (80% of hearing losses) in the presence of normal impedance audiometry (92.3%), normal transient otoacoustic emissions (84.6%) on the side of the dehiscence and the presence of replicable pathological saccades in the video head impulse test (76.9%). Disequilibrium symptoms and typical third window symptoms were absent or difficult to elicit in children (46.15 and 30.76% respectively). Only 3 (0.5%) fulfilled the adult criteria of a superior semicircular canal dehiscence syndrome. The abnormal video head impulse test characterized by pathological saccades may affect other non-dehisced ipsilateral canals. Semicircular canal dehiscences are rare in children but may be considered as an etiology for hearing losses and imbalance. Children with semicircular canal dehiscence may present differently from the classical superior semicircular canal dehiscence syndrome found in adults.
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Affiliation(s)
- Soumit Dasgupta
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sudhira Asanka Bandara Ratnayake
- Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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Altun O, Duman SB, Bayrakdar IS, Yasa Y, Duman S, Günen Yılmaz S. Cone beam computed tomography imaging of superior semicircular canal morphology: a retrospective comparison of cleft lip/palate patients and normal controls. Acta Odontol Scand 2018; 76:247-252. [PMID: 29202612 DOI: 10.1080/00016357.2017.1412498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study evaluated the prevalence and morphological characteristics of the superior semicircular canal (SSCC) in cleft lip and palate (CL/P) patients using cone beam computed tomography (CBCT). MATERIALS AND METHODS CBCT images of 53 CL/P patients (28 males and 25 females) and a control group of 76 patients (42 males and 34 females) were evaluated. Retrospectively, 258 temporal bone images from 129 patients were evaluated in terms of SSCC morphology and divided into a normal pattern (0.6-1.7 mm in thickness), a papyraceous pattern (<0.5 mm), a thick pattern (>1.8 mm), a pneumatized pattern and dehiscent. The chi-squared test was used to compare differences among semicircular canal dehiscence (SSCD) patterns in the CL/P and control groups; p ≤ .05 was taken to reflect statistical significance. RESULTS The characteristics of the SSCC were evaluated on CBCT images in patients with CL/P and controls. In total, 158 (61%) cases were normal (0.6-1.7 mm in thickness), 31 (12%) papyraceous (<0.5 mm), 8 (3%) thick, and 34 (13%) pneumatized. SSCD was observed in 27 (11%) cases. Statistically significant differences between the CL/P and control groups were evident in terms of SSCC morphology (p < .001). CONCLUSIONS SSCD should be considered if a CL/P patient exhibits a vestibular system deficiency. Oral and maxillofacial radiologists should pay attention to SSCD when interpreting CBCT images. Future studies should use high-level spatial resolution CBCT to focus on cleft site and SSCC morphology in larger patient populations.
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Affiliation(s)
- Oğuzhan Altun
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inönü University, Malatya, Turkey
| | - Suayip Burak Duman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inönü University, Malatya, Turkey
| | - Ibrahim Sevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Yasin Yasa
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ordu University, Ordu, Turkey
| | - Sacide Duman
- Department of Pedodontics, Faculty of Dentistry, Inönü University, Malatya, Turkey
| | - Sevcihan Günen Yılmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Incidence of Pediatric Superior Semicircular Canal Dehiscence and Inner Ear Anomalies: A Large Multicenter Review. Otol Neurotol 2017; 37:1370-5. [PMID: 27636391 DOI: 10.1097/mao.0000000000001194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the pediatric incidence and association of superior semicircular canal dehiscence (SSCD) with inner ear (IE) anomalies. STUDY DESIGN Retrospective chart review. SETTING Two tertiary referral centers. PATIENTS Children less than 18 years who received a 0.5 mm or less collimated computed tomography study including the temporal bones between 2010 and 2013 for reasons including, but not limited to, hearing loss, trauma, and infection. INTERVENTIONS Images were reformatted into Pöschl and Stenver planes. Five hundred three computed tomography studies (1,006 temporal bones) were reviewed by experienced, blinded neuroradiologists. MAIN OUTCOME MEASURES Incidence of SSCD and IE anomalies. Patient age, sex, and diagnosis were recorded. Statistical analysis was performed to compare outcome measures among patient demographics. RESULTS The incidence of SSCD was 6.2% (31/503) and an IE anomaly was 15.1% (76/503) of individuals. The incidence of SSCD with an IE anomaly was not significantly correlated (1.1%, 40/1,006; p = 0.23; LR = +1.29). The mean age of children with SSCD was lower (5.9 versus 9.8 yr; p = 0.002). SSCD incidence decreased with age (ages <2, 2-8, and 9-18 yr were 36.7%, 5.6%, and 3.2%; p<0.001) and SSC bone thickness nonsignificantly increased with age. Children with SSCD were commonly male (74.2%, p = 0.041). CONCLUSION SSCD and IE anomalies are unlikely related. SSCD incidence is highest in children <2 years, with SSC bone increasing until 2 to 8 years of age. This supports the theory of a congenital precedent to SSCD, with overlying bone maturation occurring during early childhood. Age <2 years was a significant predictor of SSCD.
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CDH23 Related Hearing Loss: A New Genetic Risk Factor for Semicircular Canal Dehiscence? Otol Neurotol 2017; 37:1583-1588. [PMID: 27631835 DOI: 10.1097/mao.0000000000001210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence and relative risk of semicircular canal dehiscence (SCD) in pediatric patients with CDH23 pathogenic variants (Usher syndrome or non-syndromic deafness) compared with age-matched controls. STUDY DESIGN Retrospective cohort study. SETTING Multi-institutional study. PATIENTS Pediatric patients (ages 0-5 years) were compared based on the presence of biallelic pathogenic variants in CDH23 with pediatric controls who underwent computed tomography (CT) temporal bone scan for alternative purposes. INTERVENTIONS Retrospective review of diagnostic high resolution CT temporal bone scans and magnetic resonance imaging (MRI) for evaluation of SCD. MAIN OUTCOME MEASURES Superior and posterior semicircular canals were evaluated by a neuroradiologist for presence of SCD or abnormal development. RESULTS Forty-two CT scans were reviewed for SCD. Eighty-six percent of the CDH23 variant group had abnormalities in at least one canal compared with only 12% in age-matched controls. In the CDH23 variant group there were four patients with superior SCD (57%, RR = 10.0) and three patients with posterior canal abnormalities (43%, RR = 7.5) compared with two, and two patients, respectively, in the control population. Four CDH23 variant children had bilateral abnormalities. One child had thinning or dehiscence in both the superior and posterior canals. Relative risk of SCD in children with CDH23 pathogenic variants is 7.5 (p < 0.001) compared with the pediatric control population. CONCLUSIONS Children with a CDH23 pathogenic variants are at significantly increased risk of having SCD and this may be a contributing factor to the vestibular dysfunction in Usher syndrome type 1D patient population.
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Heidenreich KD, Kileny PR, Ahmed S, El-Kashlan HK, Melendez TL, Basura GJ, Lesperance MM. Superior Canal Dehiscence Syndrome Affecting 3 Families. JAMA Otolaryngol Head Neck Surg 2017; 143:656-662. [PMID: 28384775 DOI: 10.1001/jamaoto.2016.4743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Superior canal dehiscence syndrome (SCDS) is an increasingly recognized cause of hearing loss and vestibular symptoms, but the etiology of this condition remains unknown. Objective To describe 7 cases of SCDS across 3 families. Design, Setting, and Participants This retrospective case series included 7 patients from 3 different families treated at a neurotology clinic at a tertiary academic medical center from 2010 to 2014. Patients were referred by other otolaryngologists or were self-referred. Each patient demonstrated unilateral or bilateral SCDS or near dehiscence. Interventions Clinical evaluation involved body mass index calculation, audiometry, cervical vestibular evoked myogenic potential testing, electrocochleography, and multiplanar computed tomographic (CT) scan of the temporal bones. Zygosity testing was performed on twin siblings. Main Outcomes and Measures The diagnosis of SCDS was made if bone was absent over the superior semicircular canal on 2 consecutive CT images, in addition to 1 physiologic sign consistent with labyrinthine dehiscence. Near dehiscence was defined as absent bone on only 1 CT image but with symptoms and at least 1 physiologic sign of labyrinthine dehiscence. Results A total of 7 patients (5 female and 2 male; age range, 8-49 years) from 3 families underwent evaluation. Family A consisted of 3 adult first-degree relatives, of whom 2 were diagnosed with SCDS and 1 with near dehiscence. Family B included a mother and her child, both of whom were diagnosed with unilateral SCDS. Family C consisted of adult monozygotic twins, each of whom was diagnosed with unilateral SCDS. For all cases, dehiscence was located at the arcuate eminence. Obesity alone did not explain the occurrence of SCDS because 5 of the 7 cases had a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 30.0. Conclusions and Relevance Superior canal dehiscence syndrome is a rare, often unrecognized condition. This report of 3 multiplex families with SCDS provides evidence in support of a potential genetic contribution to the etiology. Symptomatic first-degree relatives of patients diagnosed with SCDS should be offered evaluation to improve detection of this disorder.
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Affiliation(s)
- Katherine D Heidenreich
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Paul R Kileny
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Sameer Ahmed
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Hussam K El-Kashlan
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Tori L Melendez
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Gregory J Basura
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Marci M Lesperance
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
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Lagman C, Ong V, Chung LK, Elhajjmoussa L, Fong C, Wang AC, Gopen Q, Yang I. Pediatric superior semicircular canal dehiscence: illustrative case and systematic review. J Neurosurg Pediatr 2017; 20:196-203. [PMID: 28548616 DOI: 10.3171/2017.3.peds1734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study is to present an illustrative case of pediatric superior semicircular canal dehiscence (SSCD) and to systematically review the current published literature in the pediatric population. METHODS An electronic search of the Scopus, Web of Science, PsycINFO, Cochrane, and Embase databases was performed by 2 independent authors through January 2017. Search term combinations included "pediatrics," "children," "canal," and "dehiscence." Inclusion criteria were as follows: English, full-text clinical studies, case reports, and case series describing pediatric patient(s) (younger than 18 years) with CT evidence of SSCD. Baseline patient demographic characteristics, clinical presentations, dehiscence characteristics, management strategies, and outcome data were extracted. RESULTS A total of 14 studies involving 122 patients were included in the quantitative synthesis. The patients' mean age was 7.22 years. Male predominance was observed (approximate male-to-female ratio of 1.65:1). Neurodevelopmental disorders were common (n = 14, 11.5%). Auditory signs and symptoms were more common than vestibular signs and symptoms. Hearing loss (n = 62, 50.8%) was the most common auditory symptom and an indicator for imaging evaluation. Vertigo was the most common vestibular symptom (n = 8, 6.6%). Hearing aids were recommended in 8 cases (6.6%), and surgical repair was performed in 1 case (0.8%). Symptom outcomes and follow-up durations were infrequently reported. CONCLUSIONS The authors' data suggest that in pediatric SSCD, males are more commonly affected than females. This is different than the adult population in which females are predominantly affected. A history of otologic and/or neurodevelopmental abnormalities was common. There was a preponderance of auditory symptoms in this age group. Conservative management was favored in the majority.
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Affiliation(s)
| | | | | | | | | | | | | | - Isaac Yang
- Departments of 1 Neurosurgery.,Radiation Oncology, and.,Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
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CT and MR Imaging of the Pediatric Temporal Bone: Normal Variants and Pitfalls. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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The relationship of age and radiographic incidence of superior semicircular canal dehiscence in pediatric patients. Otol Neurotol 2015; 36:99-105. [PMID: 25406876 DOI: 10.1097/mao.0000000000000660] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if age affects radiographic incidence of superior semicircular canal dehiscence (SSCD) in pediatric patients. STUDY DESIGN Retrospective case review. SETTING Tertiary children's hospital. PATIENTS Patients (0-18 yr) with high-resolution computed tomography (CT) temporal bone scans from April 2001 to February 2013. INTERVENTIONS Diagnostic high-resolution CT temporal bone scans. MAIN OUTCOME MEASURES Findings of dehiscent, thin, or normal SSC on CT scans (including reconstructed Poschl views). Interobserver radiographic interpretation rate between neuroradiologist and otologist. RESULTS Seven-hundred CT scans (1,400 ears) were reviewed, and 1,188 ears were acceptable for analysis. Twenty-three ears (1.9%) had dehiscent SSC, 185 ears (15.6%) had thin SSC, and 980 ears (82.5%) had normal SSC. Median ages of dehiscent, thin, and normal canals were 5, 7, and 9 years, respectively ( p < 0.05). As age increased, the incidence of dehiscent and thin SCC cases decreased; for example, dehiscent or thin canal existed in 51.4% of children less than 12 months, 17.5% of children between 1 and 2 years, 18.5% of children between 3 and 10 years, and 10.9% of children between 11 and 18 years. The κ value of agreement between neuroradiologist and otologist was 0.814, demonstrating a high value of agreement (p < 0.05). CONCLUSION Radiographic SSCD, although uncommon, appears to be more prevalent in younger children, especially infants younger than 12 months. This suggests that the SSC may develop more bony covering with age.
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Some Remarks on Imaging of the Inner Ear: Options and Limitations. Clin Neuroradiol 2015; 25 Suppl 2:197-203. [DOI: 10.1007/s00062-015-0422-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
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Saxby AJ, Gowdy C, Fandiño M, Chadha NK, Kozak FK, Sargent MA, Lea J. Radiological prevalence of superior and posterior semicircular canal dehiscence in children. Int J Pediatr Otorhinolaryngol 2015; 79:411-8. [PMID: 25636666 DOI: 10.1016/j.ijporl.2015.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/28/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Establishing the prevalence of semicircular canal dehiscence in a pediatric population using temporal bone CT imaging. STUDY DESIGN Retrospective analysis of all temporal bone CT scans during a 5-year period (2007-2012). METHODS CT scan images were reformatted in the plane of the canals and assessed by two independent reviewers with a third to resolve disagreement. Detailed chart review was performed for those found to have dehiscence. Superior and posterior canals were classified as "dehiscent", "possibly dehiscent", "thin" or "normal" for each case. RESULTS 649 temporal bones were assessed from 334 children (under 18 years of age). The prevalence rate of superior canal dehiscence (SCD) was 1.7% (3.3% of individuals). Posterior canal dehiscence (PCD) was present in 1.2% (2.1% of individuals). There were no cases of bilateral SCD, and one case of bilateral PCD. Age under 3 years was associated with a higher prevalence of thinning but not dehiscence. Congenital inner ear malformation was not related to a higher probability of dehiscence. The superior petrosal sinus was associated with the SCD in three cases (27.3%). Retrospective chart review highlighted possible vestibular symptoms in 3/11 patients with SCD (27.3%). CONCLUSIONS This forms the largest pediatric study of canal dehiscence to date. This study's prevalence rate is significantly lower than previous reports. The identified association with overlying venous structures may reflect the etiological process involved. The occurrence in children supports the hypothesis of a congenital predisposition for development of canal dehiscence syndrome.
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Affiliation(s)
- Alexander J Saxby
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Claire Gowdy
- Department of Radiology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Marcela Fandiño
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Neil K Chadha
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Frederick K Kozak
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Michael A Sargent
- Department of Radiology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Jane Lea
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
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Kundaragi NG, Mudali S, Karpagam B, Priya R. Intracranially protruded bilateral posterior and superior SCCs with multiple dehiscences in a patient with positional vertigo: CT and MR imaging findings and review of literature. Indian J Radiol Imaging 2014; 24:406-9. [PMID: 25489134 PMCID: PMC4247510 DOI: 10.4103/0971-3026.143904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a rare case of intracranially protruded posterior and superior semicircular canals beyond the margins of temporal bone with bony roof dehiscence in bilateral posterior and left superior semicircular canals in a patient with benign paroxysmal positional vertigo (BPPV).
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Affiliation(s)
- Nischal G Kundaragi
- Department of Radiology, SRM University Medical College and Hospital, Kancheepuram, Tamil Nadu, India
| | - Srinivasa Mudali
- Department of Radiology, SRM University Medical College and Hospital, Kancheepuram, Tamil Nadu, India
| | - Bulabai Karpagam
- Department of Radiology, SRM University Medical College and Hospital, Kancheepuram, Tamil Nadu, India
| | - Rathna Priya
- Department of Radiology, SRM University Medical College and Hospital, Kancheepuram, Tamil Nadu, India
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Harrison RV. On the biological plausibility of Wind Turbine Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2014; 25:463-468. [PMID: 25295915 DOI: 10.1080/09603123.2014.963034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2014] [Indexed: 06/03/2023]
Abstract
An emerging environmental health issue relates to potential ill-effects of wind turbine noise. There have been numerous suggestions that the low-frequency acoustic components in wind turbine signals can cause symptoms associated with vestibular system disorders, namely vertigo, nausea, and nystagmus. This constellation of symptoms has been labeled as Wind Turbine Syndrome, and has been identified in case studies of individuals living close to wind farms. This review discusses whether it is biologically plausible for the turbine noise to stimulate the vestibular parts of the inner ear and, by extension, cause Wind Turbine Syndrome. We consider the sound levels that can activate the semicircular canals or otolith end organs in normal subjects, as well as in those with preexisting conditions known to lower vestibular threshold to sound stimulation.
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Affiliation(s)
- Robert V Harrison
- a Department Otolaryngology - Head and Neck Surgery , The University of Toronto, Program in Neuroscience and Mental Health, The Hospital for Sick Children , Toronto , Canada
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Evaluation of the superior semicircular canal morphology using cone beam computed tomography: a possible correlation for temporomandibular joint symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e280-8. [DOI: 10.1016/j.oooo.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 01/05/2014] [Indexed: 11/18/2022]
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Ocular vestibular evoked myogenic potentials n10 response in autism spectrum disorders children with auditory hypersensitivity: an indicator of semicircular canal dehiscence. Eur Arch Otorhinolaryngol 2013; 271:1283-8. [DOI: 10.1007/s00405-013-2736-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Dehiscence of the superior semicircular canal: a review of the literature on its possible pathogenic explanations. Eur Arch Otorhinolaryngol 2013; 271:435-7. [DOI: 10.1007/s00405-013-2497-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/11/2013] [Indexed: 10/27/2022]
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Shama SA, Eid M, Mehanna AM, Eissa LA. Dehiscences of the semicircular canals as discrete third window lesions of the inner ear. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2012.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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