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Shaul C, Weder S, Dragovic A, Gerard JM, Briggs RJS. Trans-mastoid plugging of superior semicircular canal dehiscence: long-term follow-up. Eur Arch Otorhinolaryngol 2024; 281:67-74. [PMID: 37378725 DOI: 10.1007/s00405-023-08079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To evaluate the long-term outcomes of trans-mastoid plugging of superior semicircular canal dehiscence (SSCD), focusing on complicated cases. METHODS In this cohort study, we included all patients who underwent trans-mastoid plugging of SSCD between 2009 and 2019. We evaluated the symptoms (autophony, sound-/pressure-induced vertigo, disequilibrium, aural fullness and pulsatile tinnitus) before and 1 year after surgery in the medical records. We systematically assessed the current symptoms 6.2 ± 3 years postoperative (range 2.2-12.3 years) using questionnaires sent by post and validated by telephone interviews. We also documented any complications and the need for further procedures. We compared pure tone and speech audiometry before and 1 year after surgery. Finally, the degree of mastoid pneumatisation and mastoid tegmen anatomy were reviewed on preoperative CT scans. RESULTS We included 24 ears in 23 patients. No complications were recorded, and none required a second procedure for SSCD. Following surgery, oscillopsia and Tullio phenomena resolved in all patients. Hyperacusis, autophony, and aural fullness were also settled in all patients except one. Balance impairment persisted to some degree in 35% of patients. No deterioration over the years was reported regarding the above symptoms. On average, bone conduction pure tone average pre- and 1 year postoperative were 13.7 ± 17 and 20.5 ± 18 dB, respectively (P = 0.002). Air bone gaps were reduced from 12.7 ± 8 to 5.9 ± 6 (P = 0.001). Two patients had a significant sclerotic mastoid, three had a prominent low-lying mastoid tegmen, and two had both. Anatomy had no effect on outcome. CONCLUSION Trans-mastoid plugging of SSCD is a reliable and effective technique which achieves long-lasting symptom control, even in cases with sclerotic mastoid or low-lying mastoid tegmen.
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Affiliation(s)
- Chanan Shaul
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
- Department of Otolaryngology and Head and Neck Surgery, Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Stefan Weder
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Dragovic
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Jean-Marc Gerard
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Tikka T, Mohd Slim MA, Ton T, Sheldon A, Clark LJ, Kontorinis G. Investigation of serum calcium and vitamin D levels in superior semicircular canal dehiscence syndrome: A case control study. J Otol 2023; 18:49-54. [PMID: 36820155 PMCID: PMC9937815 DOI: 10.1016/j.joto.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/22/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
Objective It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence (SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group. Methods This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period (2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups. Results A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l (SD: 20.8) compared to 47.5 nmoL/l (SD: 27.4) on the control group (p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l (SD: 0.7) for SSCD compared to 2.41 mmoL/l (SD: 0.11) for controls (p = 0.01), being within normal limits for both the SSCD and the control group. Conclusion Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.
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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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Mozaffari K, Zhang AB, Wilson B, Harary M, Chandla A, Umesh A, Gopen Q, Yang I. Evaluation of Superior Semicircular Canal Dehiscence Anatomical Location and Clinical Outcomes: A Single Institution's Experience. World Neurosurg 2022; 167:e865-e870. [PMID: 36031116 DOI: 10.1016/j.wneu.2022.08.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/20/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is becoming increasingly recognized as a pathology underlying various auditory and vestibular complaints. To date, our understanding of the pathology has yet to attribute specific symptoms to the anatomic location of dehiscence in patients with SSCD. This study aims to address this issue by evaluating the relationship between symptomatology and anatomic location of dehiscence. METHODS A single-institution retrospective review of SSCD patients was performed. Information was collected on patient demographics, symptomatology, and anatomic location of dehiscence. High-resolution computed tomography scans of the temporal bones were used to categorize the anatomic SSCD location into 1 of 3 groups: anterior limb, apex, and posterior limb. Lastly, we performed statistical analysis to determine the degree of association between each of the various perioperative factors and anatomic SSCD location. RESULTS We studied 54 patients in total (32 women, 22 men). Mean age at diagnosis was 53 years (range: 20-82 years) and mean follow-up length was 5.5 months (range: 0.03-27.0 months). The most common anatomical location of superior semicircular canal dehiscence was the apex, which was seen in 68.5% of cases. While preoperative symptomatology was similar among the 3 cohorts, those with apical dehiscences had a significantly higher rate of postoperative improvement of autophony (P = 0.03), aural fullness (P = 0.03), and tinnitus (P = 0.05) as compared to their counterparts. CONCLUSIONS Although our results do not support an association between preoperative characteristics-including symptomatology-and anatomic SSCD location, our findings do suggest that apical dehiscences are associated with greater postoperative symptomatic resolution.
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Affiliation(s)
| | - Ashley B Zhang
- Department of Neurosurgery, Los Angeles, California, USA
| | - Bayard Wilson
- Department of Neurosurgery, Los Angeles, California, USA
| | - Maya Harary
- Department of Neurosurgery, Los Angeles, California, USA
| | | | - Amith Umesh
- Department of Neurosurgery, Los Angeles, California, USA
| | - Quinton Gopen
- Department of Head and Neck Surgery, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles, California, USA; Department of Head and Neck Surgery, Los Angeles, California, USA; David Geffen School of Medicine, Los Angeles, California, USA; Department of Radiation Oncology, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, University of California, Los Angeles, Los Angeles, CA, United States.
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Gersdorff G, Blaivie C, de Foer B, Deggouj N, Wyckmans F, Somers T. Evaluation of the transmastoid plugging approach for superior semicircular canal dehiscences: a retrospective series of 30 ears. Eur Arch Otorhinolaryngol 2022; 279:4861-4869. [PMID: 35230509 DOI: 10.1007/s00405-022-07316-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The classical surgical approach for superior semicircular canal dehiscences (SSCD) is via the extradural middle cranial fossa. This pathway is used to resurface or to plug the SSC. In this paper, we present long-term data on an alternative route: the transmastoid pathway. The predictive factors for a successful surgery are equally presented in this paper. METHODS Thirty reports of patients operated between September 2007 to January 2020 were analysed. SSCD was confirmed by the association of concordant complaints, audiometric data, cervical vestibular evoked myogenic potentials (cVEMP) responses and computerized tomography findings. Before and after surgery, the following factors were analysed: auditory and vestibular subjective symptoms, Tullio phenomenon, pure-tone audiometry thresholds for air and bone conduction, air-bone gap, cVEMP threshold, and computerized tomography data, for instance the size of the dehiscence. RESULTS The follow-up is 21 months on average. The transmastoid approach significantly improves all symptoms (although there were less probing results for the vestibular symptoms). Objectively, we can observe, a closure of the audiometric air-bone gap on the low frequencies and an improvement in the cVEMP. The only correlation that was identified was between the preoperative cVEMP results and the postoperative air conduction. CONCLUSIONS The originality of this study is the long postoperative follow-up. It allowed us to evaluate the symptoms in the long term and to determine a predictive factor of postoperative complication, which has not yet been described until today.The transmastoid plugging technique is safe and effective. Additional long-term data with a larger cohort are needed to confirm our results and correlation studies.
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Affiliation(s)
- Guillaume Gersdorff
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, St Luc University Hospital, Brussels, Belgium. .,ENT Department, Saint-Luc Hospital, Avenue Hippocrate 10, 1200, Bruxelles, Belgium.
| | - Catherine Blaivie
- Department of Oto-Rhino-Laryngology-Head and Neck and Skull Base Surgery, Sint Augustinus Hospital, Antwerp, Belgium
| | - Bert de Foer
- Department of Radiology, GZA Hospitals, Antwerp, Belgium
| | - Naïma Deggouj
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, St Luc University Hospital, Brussels, Belgium
| | - Florent Wyckmans
- Psychological Medicine Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Somers
- Department of Oto-Rhino-Laryngology-Head and Neck and Skull Base Surgery, Sint Augustinus Hospital, Antwerp, Belgium.,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, St Luc University Hospital, Brussels, Belgium
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Superior semicircular canal dehiscence: a narrative review. The Journal of Laryngology & Otology 2021; 136:284-292. [PMID: 34615564 DOI: 10.1017/s0022215121002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mozaffari K, Ghodrati F, Pradhan A, Ng E, Ding K, Rana S, Duong C, Anderson RN, Enomoto A, Sheppard JP, Sun MZ, Phillips HW, Yang I, Gopen Q. Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience. World Neurosurg 2021; 156:e408-e414. [PMID: 34583007 DOI: 10.1016/j.wneu.2021.09.083] [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: 08/12/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an abnormality of the otic capsule, which normally overlies the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. Given the complexity of the disease, there are patients who experience less favorable surgical outcomes and require revision surgery. The purpose of this study was to report to the rate of postoperative symptomatic improvement in patients who required revision surgery. METHODS A retrospective analysis of patients undergoing SSCD surgical repair at a single institution was performed. Information on patient demographics, primary and secondary surgical approaches, surgical outcomes, and follow-up length was collected. RESULTS Seventeen patients underwent 20 revision surgeries. There were eleven (65%) females and six (35%) males. Mean age of the cohorts was 50 years (range 30-68 years), and mean follow-up length was 6.8 months (range 0.1-31.1 months). Cerebrospinal fluid leak was noted in 67% of cases. The greatest postoperative symptomatic resolution was reported in oscillopsia (100%), headache (100%), and internal sound amplification (71%), while the least postoperative symptomatic resolution was reported in tinnitus (42%), aural fullness (40%), and dizziness (29%). CONCLUSIONS Revision surgery can provide symptomatic improvement in select SSCD patients; however, patients should be cautioned about the possibility of less favorable outcomes than in index surgery. Revision surgeries are associated with a considerably higher rate of perioperative cerebrospinal fluid leak.
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Affiliation(s)
- Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Farinaz Ghodrati
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Anjali Pradhan
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Kevin Ding
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Shivam Rana
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Roan N Anderson
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Adam Enomoto
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - H Westley Phillips
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
| | - Quinton Gopen
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
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Bhatt AA, Lundy LB, Middlebrooks EH, Vibhute P, Gupta V, Rhyner PA. Superior Semicircular Canal Dehiscence : Covering Defects in Understanding from Clinical to Radiologic Evaluation. Clin Neuroradiol 2021; 31:933-941. [PMID: 34097081 DOI: 10.1007/s00062-021-01037-x] [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: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Superior semicircular canal dehiscence alters the normal fluid mechanics of the vestibulocochlear system and can be a debilitating condition. This article reviews the current understanding of the bony labyrinthine defect, including symptoms, etiology, surgical approach, as well as preoperative and postoperative imaging pearls.
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Affiliation(s)
- Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA.
| | - Larry B Lundy
- Department of Otolaryngology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Patricia A Rhyner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
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Pirodda A, Brandolini C. Semicircular canal dehiscence: a possible direct cause of benign paroxysmal positional vertigo? HEARING, BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1631048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Antonio Pirodda
- Department of Diagnostic, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cristina Brandolini
- Department of Diagnostic, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
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Preet K, Udawatta M, Duong C, Gopen Q, Yang I. Bilateral Superior Semicircular Canal Dehiscence Associated with Ehlers-Danlos Syndrome: A Report of 2 Cases. World Neurosurg 2019; 122:161-164. [DOI: 10.1016/j.wneu.2018.10.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 02/04/2023]
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Banakis Hartl RM, Cass SP. Effectiveness of Transmastoid Plugging for Semicircular Canal Dehiscence Syndrome. Otolaryngol Head Neck Surg 2018; 158:534-540. [PMID: 29313443 PMCID: PMC6154498 DOI: 10.1177/0194599817751092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/08/2017] [Indexed: 12/19/2022]
Abstract
Objectives (1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome. Study Design Case series with chart review. Setting Single tertiary care institution. Subjects and Methods We retrospectively reviewed patients with SSCD who underwent repair with canal plugging via a transmastoid approach between January 2012 and January 2017. Symptom severity was assessed prospectively (autophony, sound/pressure-induced vertigo, disequilibrium, aural fullness, and pulsatile tinnitus) and after surgery. Pure-tone and speech audiometry were measured before and after surgery. Two-sided Wilcoxon rank-sum tests were used to evaluate changes in subjective symptoms and audiometric outcomes. Results Seventeen patients (19 ears) met inclusion criteria. The superior canal was successfully plugged via the transmastoid approach in all cases. Patients reported a statistically significant improvement in autophony, vertigo, aural fullness, and pulsatile tinnitus ( P < .01), without significant improvement in disequilibrium rating ( P = .06). There were no changes noted in pure-tone average or word recognition score; however, there was a statistically significant improvement in air-bone gap at 250 Hz of 10.9 dB ( P = .04) with 12.9-dB improvement in air conduction thresholds ( P = .02) and no difference (0.9 dB, P = .9) in bone conduction thresholds. Conclusion In our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach.
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Affiliation(s)
| | - Stephen P. Cass
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
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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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Ung N, Chung LK, Lagman C, Bhatt NS, Barnette NE, Ong V, Gopen Q, Yang I. Outcomes of middle fossa craniotomy for the repair of superior semicircular canal dehiscence. J Clin Neurosci 2017. [PMID: 28622893 DOI: 10.1016/j.jocn.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) is a rare defect of the arcuate eminence that causes an abnormal connection between the superior semicircular canal and middle cranial fossa. Patients often present with a variety of auditory and vestibular symptoms. Trigger avoidance is the initial strategy, but surgery may be necessary in debilitating cases. We retrospectively reviewed SSCD patients undergoing repair via a middle fossa craniotomy between March 2011 and September 2015. Forty-nine patients undergoing 58 surgeries were identified. Autophony was the most common symptom at presentation (n=44; 90%). Mean follow-up was 10.9months, with 100% of patients reporting resolution of at least one symptom. Aural fullness was the most commonly resolved symptom following surgical repair (n=19/22; 86%). Hearing loss (n=11/25; 44%) and tinnitus (n=11/38; 29%) were the most common symptoms to persist following surgery. The most common symptom to develop after surgery was disequilibrium (n=4/18; 22%). Upon comparing the overall pre-operative and post-operative groups, the number of patients with autophony (p<0.0001), aural fullness (p=0.0006), hearing loss (p=0.0119), disequilibrium (p=0.0002), sound- and pressure-induced vertigo (p<0.0001), and tinnitus (p<0.0001) were significantly different. Improved clinical outcomes were demonstrated in patients undergoing SSCD repair through a middle cranial fossa approach. The most common presenting symptom (autophony) was also most likely to resolve after surgery. Hearing loss is less amenable to surgical correction. Disequilibrium developed in a small number of patients after repair.
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Affiliation(s)
- Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nikhilesh S Bhatt
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Natalie E Barnette
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Vera Ong
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Quinton Gopen
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States; Department of Head and Neck Surgery, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6901, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States; Department of Head and Neck Surgery, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6901, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States; Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States.
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Pirodda A, Savastio G, Stagni S, Ferri GG, Brandolini C, Zompatori M. The role of high-resolution computed tomography in the diagnostic protocol of cochleo-vestibular disorders. HEARING, BALANCE AND COMMUNICATION 2017. [DOI: 10.1080/21695717.2017.1286085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Pirodda
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | | | - Gian Gaetano Ferri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cristina Brandolini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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15
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Sandhu JS, Manickavasagam J, Connolly D, Raghavan A, Fernando M, Ray J. Comparison of radiologically and histologically determined thickness of bone overlying the superior semicircular canal in sixty-six cadaveric specimens: impact on the diagnosis of Minor's Syndrome. Clin Otolaryngol 2016; 42:847-850. [PMID: 27385626 DOI: 10.1111/coa.12697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J S Sandhu
- Ear Nose and Throat Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - J Manickavasagam
- Ear Nose and Throat Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - D Connolly
- Department of Radiology, Sheffield Children's NHS Foundation, Sheffield, UK
| | - A Raghavan
- Department of Radiology, Sheffield Children's NHS Foundation, Sheffield, UK
| | - M Fernando
- Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK
| | - J Ray
- Ear Nose and Throat Department, Sheffield Teaching Hospitals, Sheffield, UK
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16
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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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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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Sepúlveda I, Schmidt T, Platín E. Use of cone beam computed tomography in the diagnosis of superior semicircular canal dehiscence. J Clin Imaging Sci 2014; 4:49. [PMID: 25337435 PMCID: PMC4204297 DOI: 10.4103/2156-7514.141554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/19/2014] [Indexed: 11/04/2022] Open
Abstract
Superior semicircular canal dehiscence is a relatively new syndrome in the field of otology. It is of unknown etiology presenting with a variety of vestibular and auditory symptoms and radiologic findings play a crucial role in its diagnosis. Cone beam computed tomography has been shown to be a powerful tool in the field of otolaryngology. It is a three dimensional technique that uses lower radiation resulting in fewer artifacts and offers higher resolution when compared with multi-slice computed tomography. It is considered to be an excellent imaging modality for radiological exploration of the ear.
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Affiliation(s)
- Ilson Sepúlveda
- Department of Oral and Maxillofacial Radiology, Otolaryngology Head and Neck Surgery Service General Hospital of Concepcion, Cone Beam Concepcion, Advanced Craniofacial Imaging Center, Finis Terrae University School of Dentistry, Santiago, Chile
| | - Thomas Schmidt
- Department of Physician Otolaryngologist, Otolaryngology Head and Neck Surgery Service, General Hospital of Concepcion. University of Concepción School of Medicine, Concepción, Chile
| | - Enrique Platín
- Department of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
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