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Wang BL, Bartholomew RA, Dattilo LW, Williams MM, Corrales CE, Lee DJ, Bhattacharyya N. Association Between Superior Canal Dehiscence Syndrome and Anxiety and Depressive Disorders. Laryngoscope 2024; 134:3879-3880. [PMID: 38924149 DOI: 10.1002/lary.31595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Brigette L Wang
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ryan A Bartholomew
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Lillian W Dattilo
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Marta M Williams
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Carleton E Corrales
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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2
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Rueda Vega M, López Granados C, Arístegui Torrano I, Martín Sanz E, Arístegui Ruiz M. Superior semicircular canal dehiscence in relation with the superior petrosal sinus: our experience, surgical management and systematic review of literature. Eur Arch Otorhinolaryngol 2024; 281:4665-4675. [PMID: 38698161 DOI: 10.1007/s00405-024-08682-1] [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: 02/13/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Most of Superior Semicircular Canal Dehiscence (SSCD) are located in the apical region of the SSC. However, in a small number of cases, it may be situated in the medial wall, causing the SSC to contact with the superior petrosal sinus (SPS). The aim of this study is to describe four patients with SSCD involving the superior petrosal sinus (SSCD-SPS) and to perform a review of the literature. METHODS Observational retrospective study of patients diagnosed of SSCD-SPS in a tertiary referral center. A systematic review was made, identifying 7 articles in the literature. Clinical presentation, complementary test (pure-tone audiometry, PTA; vestibular evoked myogenic potential, VEMP; computed tomography, CT), therapeutic management and outcomes were reported. RESULTS Four new cases of SSCD-SPS are reported, in three of them a transmastoid plugging was performed. 54 patients with SSCD-SPS (57 dehiscences) were reported in the literature. The most frequent symptoms were aural pressure (57.41%) and vertigo provoked by pressure/Valsalva (55.55%). Conductive hearing loss was the most common finding in PTA (47.37%). Abnormally low thresholds were observed in 59.46% of reported VEMP. Transmastoid approach was used in ten cases, middle fossa approach in four, round window reinforcement in one, and occlusion of the SPS using coils in two. CONCLUSIONS Within SSCD, we have encountered a rare subtype characterized by its medial wall location in close proximity to the SPS. This subgroup needs special consideration as it has shown its own distinct characteristics. Regarding therapeutic management, we advocate a transmastoid approach.
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Affiliation(s)
- Monica Rueda Vega
- Department of Otolaryngology-Head and Neck Surgery, Hospital General Universitario Gregorio Marañón., C/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Carolina López Granados
- Department of Otolaryngology-Head and Neck Surgery, Hospital General Universitario Gregorio Marañón., C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Ignacio Arístegui Torrano
- Department of Otolaryngology-Head and Neck Surgery, Hospital General Universitario Gregorio Marañón., C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Eduardo Martín Sanz
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Miguel Arístegui Ruiz
- Department of Otolaryngology-Head and Neck Surgery, Hospital General Universitario Gregorio Marañón., C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
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3
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Van Dijk SW, Peters JPM, Stokroos RJ, Thomeer HGXM. Surgical decision-making in superior canal dehiscence syndrome with concomitant otosclerosis. Eur Arch Otorhinolaryngol 2024; 281:3859-3865. [PMID: 38780629 PMCID: PMC11211118 DOI: 10.1007/s00405-024-08679-w] [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: 11/22/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The diagnosis and management of Superior Canal Dehiscence Syndrome (SCDS) with concomitant otosclerosis can be a challenge. Otosclerosis can mask SCDS symptoms and stapes surgery may reveal or exacerbate vestibular symptoms. Our aim is to present four cases of SCDS with concomitant otosclerosis and thereby informing the reader about the possibility of this dual occurrence and its implications for treatment. CASES Four patients with SCDS and concomitant otosclerosis are presented. Two patients underwent surgical treatment for both SCDS and otosclerosis and two patients opted for conservative management. OUTCOMES The main differences between surgically and non-surgically treated cases are the presence of autophony and pressure-induced vertigo and a more severe experience of symptoms in surgically treated cases. Surgically treated cases achieved a sizeable reduction in postoperative air-bone gap and resolution of vestibular symptoms. CONCLUSION The subjective severity of symptoms in combination with shared decision-making is key in determining the appropriate treatment plan for SCDS and concomitant otosclerosis.
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Affiliation(s)
- S W Van Dijk
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - J P M Peters
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - R J Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - H G X M Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
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4
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Paknahad M, Karimnezhand Khas R, Hasani M. Comparison of Superior Semicircular Canal Bone Thickness and Patterns in Unilateral and Bilateral Cleft Patients and Normal Controls: A CBCT Study. Cleft Palate Craniofac J 2024; 61:1172-1178. [PMID: 37073078 DOI: 10.1177/10556656231165189] [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] [Indexed: 04/20/2023] Open
Abstract
Superior Semicircular Canal Dehiscence (SSCD) is a recently-defined developmental defect may be associated with several craniofacial anomalies such as Cleft Lip/Palate (CLP). The present study aimed to compare subjects with unilateral and bilateral CLP and normal controls in terms of Superior Semicircular Canal (SSC) bone thickness and pattern. A total of 238 Cone Beam Computed Tomography (CBCT) images were collected from 52 unilateral Cleft Lip and Palate (UCLP) subjects (104 temporal bones) and 38 Bilateral Cleft Lip and Palate (BCLP) (76 temporal bones) subjects and 148 healthy controls (296 temporal bones). The SSC bone thickness was measured twice and validated by a maxillofacial radiologist. The samples were then classified into five categories based on bone thickness: papyraceous or thin, normal, thick, pneumatized, and dehiscence. After all, the UCLP, BCLP, and normal control groups were compared concerning the SSC pattern and thickness. The results revealed no significant difference among the three groups regarding the SSC pattern and thickness based on gender. The SSC patterns (P value = .001) and SSC thickness (0.01) were strongly correlated to the cleft type. The thinnest bone thickness and the highest incidence of SSCD were observed among the subjects with BCLP. The results showed a significant association between the SSC patterns and SSC thickness and the study groups.
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Affiliation(s)
- Maryam Paknahad
- Oral and Dental Disease Research Center, Oral and Maxillofacial Radiology Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahvash Hasani
- Oral & Maxillofacial Radiology Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Sawada M, Matsuda H, Tanzawa Y, Sakamoto K, Kudo H, Nakashima M, Ikezono T. Practicality of multilayer round window reinforcement in the surgical management of superior semicircular canal dehiscence syndrome: a case report of long-term follow-up. Front Neurol 2024; 15:1393648. [PMID: 38966088 PMCID: PMC11222960 DOI: 10.3389/fneur.2024.1393648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/31/2024] [Indexed: 07/06/2024] Open
Abstract
Several surgical techniques have been documented for approaching and repairing superior semicircular canal dehiscence syndrome (SCDS). These techniques encompass the trans-middle cranial fossa, transmastoid, endoscopic approaches, and round window reinforcement (RWR). RWR entails the placement of connective tissue with or without cartilage and around the round window niche, restricting the round window's movement to minimize the 3rd window effect and restore the bony labyrinth closer to its normal state. We employed the multilayer RWR technique, resulting in significant postoperative improvement and long-lasting effects for 3.7 years in 2 cases. Here, we present the clinical findings, surgical procedures, and the effectiveness of multilayer RWR. This technique can be the initial choice for surgical treatments of SCDS due to its high effectiveness, longer-lasting effect, and minimal risk of surgical complications.
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Affiliation(s)
- Masafumi Sawada
- Department of Otolaryngology and Neuro-Otology, Saitama Medical University Hospital, Saitama, Japan
| | | | | | | | | | | | - Tetsuo Ikezono
- Department of Otolaryngology and Neuro-Otology, Saitama Medical University Hospital, Saitama, Japan
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Patel S, Rodrigues R, Gall EK, Kosarchuk JJ, Heilman C, Noonan K. The History of Superior Semicircular Canal Dehiscence: A Bibliometric Analysis. World Neurosurg 2024; 185:e591-e602. [PMID: 38395350 DOI: 10.1016/j.wneu.2024.02.082] [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: 11/10/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE The treatment and understanding of superior semicircular canal dehiscence (SSCD) has seen significant developments over the past 25 years. Bibliographic analysis can provide insight into the evolution of research as well as highlight emerging areas. Reviewing a large volume of publications provides valuable insights into the citation patterns and collaborations of research groups. This study seeks to offer a comprehensive historical overview of SSCD and leading authors. DATABASE REVIEWED Web of Science Core Collection. METHODS A bibliometric analysis of the current literature on SSCD was conducted. A performance analysis and science mapping of the top 100 most cited articles was completed using a citation analysis. Two independent reviewers evaluated articles for relevance and adjugated by a third reviewer. Author and institution networks were examined. RESULTS Seven hundred ninety-one articles on the topic of SSCD were identified. The top 100 articles spanned over 23 years from 1998 to 2019 and were published in 30 different journals. The top 100 articles were cited 8253 times in literature. The document contents revealed 233 keywords and 238 author keywords. The articles were authored by a total of 291 authors, with only 4 single-authored documents. CONCLUSIONS SSCD has been highly researched in aspects of symptomatology, diagnosis, and treatment, as indicated by many highly cited articles that relate. However, the production of highly cited articles on SSCD displays a significant decrease after 2013, with only 17 of the top cited articles published since then.
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Affiliation(s)
- Shrey Patel
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Rahul Rodrigues
- School of Medicine, Tufts University, Boston, Massachusetts, USA.
| | - Emily K Gall
- Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jacob J Kosarchuk
- Department of Neurological Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carl Heilman
- Department of Neurological Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kathryn Noonan
- Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Hançer Arslan G, Arslan M, Aran OT, Özberk EH, Baydan Aran M. Effectiveness of the sternocleidomastoid muscle contraction asymmetry and filter: cervical vestibular evoked myogenic potential. J Laryngol Otol 2024; 138:410-415. [PMID: 37581001 DOI: 10.1017/s0022215123001366] [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] [Indexed: 08/16/2023]
Abstract
OBJECTIVE This study aimed to determine the precautions that can be taken to increase the reliability of the vestibular evoked myogenic potentials test without being affected by the asymmetry of the sternocleidomastoid muscle and the issues that should be considered in the interpretation of vestibular evoked myogenic potential results if these precautions are not taken. METHOD Individuals with sternocleidomastoid muscle activity of less than 30 μV in cervical vestibular evoked myogenic potential testing and an asymmetry ratio of more than 0.35 were excluded. In our study, individuals were divided into different groups according to sternocleidomastoid muscle asymetry. RESULTS A total of 53 individuals were included in the study. Intergroup comparisons were made to determine the effect of electromyogram scaling and filter use on amplitude asymmetry ratio according to sternocleidomastoid muscle asymmetry. CONCLUSION Keeping the sternocleidomastoid muscle asymmetry not exceeding 10 μV maximises the reliability of cervical vestibular evoked myogenic potentials. As a result of our study, it can be concluded that in clinical applications the asymmetry should not exceed 20 μV.
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Affiliation(s)
- G Hançer Arslan
- Department of Audiometry, Vocational School of Health Services, Trakya University, Edirne, Turkey
| | - M Arslan
- Department of Audiology, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - O T Aran
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - E H Özberk
- National Foundation for Educational Research, London, UK
| | - M Baydan Aran
- Department of Audiology, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Benchetrit L, Shave S, Garcia A, Chung JJ, Suresh K, Lee DJ. Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome. Front Neurol 2024; 15:1336627. [PMID: 38469592 PMCID: PMC10925929 DOI: 10.3389/fneur.2024.1336627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair. Study design Retrospective chart review. Setting Tertiary neurotology single-institution care center. Main outcome measures The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups. Results Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05). Conclusions Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head, and Neck Surgery, Boston University, Boston, MA, United States
| | - Samantha Shave
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head, and Neck Surgery, University of Iowa, Iowa City, IA, United States
| | - Janice J Chung
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
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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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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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11
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Hong M, Mozaffari K, Uy B, Kim WJ, Umesh A, Chandla A, Unterberger A, Yang I, Gopen Q. Postoperative Outcomes of Patients with Thin Bone Overlying the Superior Semicircular Canal: A Single Institution's Experience. World Neurosurg 2022; 166:e93-e98. [PMID: 35779752 DOI: 10.1016/j.wneu.2022.06.118] [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: 05/19/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is defined by a bony defect overlying the superior semicircular canal (SSC) in the middle cranial fossa floor, causing a myriad of vestibular and auditory symptoms. Patients with thin bone without full dehiscence overlying the SSC also present with similar symptoms. There are currently no guidelines for surgical management of patients with thin bone. The authors offer their experience with thin bone patients to characterize their symptomatology and explore whether these patients benefit from surgical intervention typically offered to SSCD patients. METHODS Two hundred fifty-six patients evaluated for SSCD from 2011 to 2019 were reviewed. High-resolution coronal computed tomography scans with 0.6-mm slice thickness of the temporal bones were assessed to determine whether the patient had a true dehiscence or a thin bone covering overlying the SSC. Bone that was ≤0.5 mm was considered to be "thin bone." Parameters of interest included patient demographics as well as preoperative and postoperative symptomatology. A P value < 0.05 was considered statistically significant. RESULTS Forty-eight patients met inclusion criteria of having "thin bone." The mean age was 48.13 ± 12.03 years, and 65.5% of patients were female. Of the preoperative symptoms evaluated, the greatest postoperative symptomatic resolution was noted in hearing loss (92.3%), vertigo (94.4%), and oscillopsia (100%). Dizziness (56.5%) had the lowest symptomatic resolution rate. CONCLUSIONS Surgical management of thin bone patients via middle fossa craniotomy, a similar technique to SSCD repair, provides significant symptomatic resolution. Therefore, surgery should be considered in thin bone patients with debilitating symptoms, albeit not having a true dehiscence.
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Affiliation(s)
- Michelle Hong
- UCLA Department of Head and Neck Surgery, Los Angeles, California, USA
| | | | - Benjamin Uy
- UCLA Department of Neurosurgery, Los Angeles, California, USA
| | - Wi Jin Kim
- UCLA Department of Neurosurgery, Los Angeles, California, USA
| | - Amith Umesh
- UCLA Department of Neurosurgery, Los Angeles, California, USA
| | - Anubhav Chandla
- UCLA Department of Neurosurgery, Los Angeles, California, USA
| | | | - Isaac Yang
- UCLA Department of Head and Neck Surgery, Los Angeles, California, USA; UCLA Department of Neurosurgery, Los Angeles, California, USA; Office of the Patient Experience at UCLA, Los Angeles, California, USA; UCLA Department of Radiation Oncology, Los Angeles, California, USA; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, California, USA.
| | - Quinton Gopen
- UCLA Department of Head and Neck Surgery, Los Angeles, California, USA; UCLA Department of Radiation Oncology, Los Angeles, California, USA; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
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12
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Assessment of Metabolic Markers and Osteoporosis in 250 Patients with Superior Semicircular Canal Dehiscence Treated With Middle Fossa Craniotomy. World Neurosurg 2022; 166:e52-e59. [PMID: 35760329 DOI: 10.1016/j.wneu.2022.06.090] [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: 05/15/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is caused by bony defects in the osseous shell of the arcuate eminence separating the labyrinth and the intracranial space. This pathologic third window causes hydroacoustic transmission resulting in debilitating symptoms. We examine the pathophysiologic association between metabolic markers, previous medical history, and SSCD symptoms before and after middle fossa craniotomy (MFC) treatment. METHODS This study was conducted between March 2011 and September 2020 with patients with SSCD who underwent MFC. We used a Fisher test to compare variables, including bilateral SSCD, second surgery, ear anomaly, osteoporosis, arthritis, vitamin D, and preoperative/postoperative symptoms, and others. Point-biserial correlation analysis was performed to test correlations between continuous variables and categorical variables. RESULTS A total of 250 patients with SSCD underwent MFC repair. There was significant postoperative resolution in all symptoms (P < 0.0001). Laboratory 25-hydroxyvitamin D values correlated with preoperative aural fullness (rpb= 0.29; P = 0.03), and preoperative disequilibrium (rpb= -0.32; P = 0.02). Serum calcium values correlated with preoperative hearing loss (rpb= 0.16; P = 0.02). Osteoporosis history (n = 16; 6%) was more prevalent in female patients (P = 0.0001), associated with higher levels of preoperative hearing loss (odds ratio, 4.56; P = 0.02) and higher postoperative hearing loss resolution (odds ratio, 2.89; P = 0.0509). CONCLUSIONS Certain metabolic markers may predict SSCD presentation before and after surgery. Previous history of osteoporosis, autoimmune conditions, or arthritis may play a role in SSCD pathophysiology and can help predict clinical outcomes. Future evaluation should take metabolic laboratory values and acquire an exact medical history.
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13
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Fei S, Guangfei L, Jie M, Yiling G, Mingjing C, Qingxiang Z, Wei M, Shuangba H. Development of semicircular canal occlusion. Front Neurosci 2022; 16:977323. [PMID: 36061608 PMCID: PMC9437460 DOI: 10.3389/fnins.2022.977323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Surgical treatment of vertigo is performed with in-depth study of inner ear diseases. Achieving an effective control of vertigo symptoms while reducing damage to hearing and reducing surgical complications is the principle followed by scholars studying surgical modalities. Semicircular canal occlusion is aimed at treatment of partial peripheral vertigo disease and has attracted the attention of scholars because of the above advantages. This article provides a review of the origins of semicircular canal occlusion, related basic research, clinical applications, and the effects of surgery on vestibular and hearing function.
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Affiliation(s)
- Su Fei
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Li Guangfei
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Meng Jie
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Gao Yiling
- Department of Pharmacy, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Cai Mingjing
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Zhang Qingxiang
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Meng Wei
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
- *Correspondence: Meng Wei
| | - He Shuangba
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Nanjing Tongren Hospital, Southeast University, Nanjing, China
- He Shuangba
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14
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Bijou W, El Krimi Z, Abdulhakeem B, Oukessou Y, Mahtar M. Asymptomatic multiple semicircular canal dehiscence: a rare entity. Oxf Med Case Reports 2022; 2022:omab125. [PMID: 35903617 PMCID: PMC9318877 DOI: 10.1093/omcr/omab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Walid Bijou
- ENT Department , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
- Hospital August, University Hospital Center IBN ROCHD , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
| | - Zineb El Krimi
- ENT Department , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
- Hospital August, University Hospital Center IBN ROCHD , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
| | - Bushra Abdulhakeem
- ENT Department , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
- Hospital August, University Hospital Center IBN ROCHD , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Department , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
- Hospital August, University Hospital Center IBN ROCHD , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
| | - Mohamed Mahtar
- ENT Department , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
- Hospital August, University Hospital Center IBN ROCHD , Face and Neck Surgery, , Hassan II University, Casablanca, Morocco
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15
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Morrison M, Korda A, Wagner F, Caversaccio MD, Mantokoudis G. Case Report: Fremitus Nystagmus in Superior Canal Dehiscence Syndrome. Front Neurol 2022; 13:844687. [PMID: 35614919 PMCID: PMC9124807 DOI: 10.3389/fneur.2022.844687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Superior canal dehiscence syndrome (SCDS) is a structural bony defect of the roof of the superior semi-circular canal into the middle cranial fossa and is responsible for the creation of a third window, which alters the dynamics of the inner ear. During humming, vibratory waves entering the vestibulum and cochlea are re-routed through the dehiscence, leading to stimulation of the otolithic and ampullary vestibular organs. This is responsible for the torsional-vertical nystagmus known as “fremitus nystagmus”. In this case report, we video-document a rare case of fremitus nystagmus and its resolution after plugging of the superior semi-circular canal.
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Affiliation(s)
- Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
- *Correspondence: Georgios Mantokoudis
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16
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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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17
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Reynard P, Idriss S, Ltaief-Boudrigua A, Bertholon P, Pirvan A, Truy E, Thai-Van H, Ionescu EC. Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities. Front Neurol 2022; 12:792545. [PMID: 35087471 PMCID: PMC8786803 DOI: 10.3389/fneur.2021.792545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants. Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities. Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed. Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.
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Affiliation(s)
- Pierre Reynard
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Samar Idriss
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | | | - Pierre Bertholon
- Department of Otorhinolaryngology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Andreea Pirvan
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France
| | - Eric Truy
- Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Department of Otorhinolaryngology, Lyon University Hospital, Lyon, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Eugen C Ionescu
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
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18
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Inal M, Bayar Muluk N, Asal N, Çelik EN. Peripheric smell regions in patients with semicircular canal dehiscence: An MRI evaluation. J Clin Neurosci 2021; 94:173-178. [PMID: 34863433 DOI: 10.1016/j.jocn.2021.10.019] [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: 05/05/2021] [Revised: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated the peripheric smell regions in patients with semicircular canal dehiscence (SCD) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 186 adult patients were included. Group 1 consisted of 83 adult patients with SCD. The control group (Group 2) consisted of 83 healthy subjects without central vertigo. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth were measured in all groups. RESULTS In group 1, SCD was detected on the right (33.7%), left (26.5%) sides and bilateral (39.8%). Localization of dehiscence was at superior SC (75.9%), posterior SC (21.7%), lateral SC (1.2%), and posterior + superior SCs (1.2%). OB volumes of the SCD group were significantly lower than the control group bilaterally (p < 0.05). There were no significant differences between OS depths of groups 1 and 2 (p > 0.05). In SCD group, there were positive correlations between OB volumes; OS depths; and OB volumes and OS depths (p < 0.05). In older patients, bilateral OS depth values got lower (p < 0.05). In females, left OB volume values were lower than males (p < 0.05). In right SCD (+) patients, left OS depth values got lower (p < 0.05). CONCLUSION We concluded that possible changes in CSF dynamics may cause the development of SCD at thin bone segments; and a decrease in the OB volume. CSF leaks into the perineural sheet of the olfactory bulb (OB) maybe responsible for the decrease in the OB volume. In addition, minor trauma, infection, and inflammation may also be responsible for both coexistences of SCD development and OB volume decrease.
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Affiliation(s)
- Mikail Inal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Neşe Asal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Enes Nusret Çelik
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
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19
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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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20
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Preet K, Udawatta M, Mozaffari K, Ong V, Franks A, Ng E, Gaonkar B, Sun MZ, Salamon N, Gopen Q, Yang I. Relationship Between Superior Semicircular Canal Dehiscence Volume with Clinical Symptoms: Case Series. World Neurosurg 2021; 156:e345-e350. [PMID: 34562630 DOI: 10.1016/j.wneu.2021.09.070] [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: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an osseous defect of the arcuate eminence of the petrosal temporal bone. Patients typically present with auditory and vestibular symptoms, such as hearing loss and disequilibrium. Using advanced imaging segmentation techniques, we evaluated whether the volume of SSCD correlated with preoperative symptoms and postoperative outcomes. METHODS Our laboratory previously described a novel method of quantifying the size of an SSCD via manual segmentation. High-resolution computed tomography images of the temporal bones were imported into a specialized segmentation software. The volume of the dehiscence was outlined on consecutive slices of the coronal and axial planes via a single-pixel-thick paintbrush tool and was then calculated according to the number of nonzero image voxels. RESULTS This study included 111 patients (70 women and 41 men; mean age, 55.1 years; age range, 24-87 years) with a total of 164 SSCDs. Mean postoperative follow-up time was 5.2 months (range, 0.03-59.5 months). The most common preoperative and postoperative symptoms were tinnitus (n = 85) and dizziness (n = 45), respectively. Surgery resulted in improvement of symptoms in most patients. The average volume of 164 SSCDs was 1.3 mm3. SSCD volume was not significantly associated with either preoperative symptoms or postoperative outcomes. CONCLUSIONS Advances in imaging techniques have allowed increased visualization of SSCD. Further research will be necessary to evaluate the potential correlation of volume of the dehiscence with clinical variables.
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Affiliation(s)
- Komal Preet
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Vera Ong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Alyssa Franks
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Bilwaj Gaonkar
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Quinton Gopen
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA.
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21
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Mozaffari K, Willis SL, Unterberger A, Duong C, Hong M, De Jong R, Mekonnen M, Johanis M, Miao T, Yang I, Gopen Q. Superior Semicircular Canal Dehiscence Outcomes in a Consecutive Series of 229 Surgical Repairs With Middle Cranial Fossa Craniotomy. World Neurosurg 2021; 156:e229-e234. [PMID: 34547526 DOI: 10.1016/j.wneu.2021.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is the appearance of a third mobile window between the middle fossa and the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. The purpose of this study was to evaluate the association between preoperative variables that may impact postoperative symptomatic resolution. METHODS A single-institution retrospective analysis was performed on patients who were surgically treated for SSCD. Patients were divided to different cohorts based on unilateral or bilateral nature of the disease. A P value <0.05 was considered statistically significant. RESULTS A total of 229 surgical repairs were analyzed. Mean age was 51 years (± 7.8 years), and 55.9% of patients were female. All cohorts were similar with respect to baseline demographics. The most commonly reported preoperative symptoms were tinnitus, dizziness, and autophony. The greatest symptomatic resolution was seen in autophony, internal sound amplification, hyperacusis, and oscillopsia. The unilateral SSCD cohort had significantly higher improvement of autophony (P = 0.003), aural fullness (P = 0.05), tinnitus (P = 0.006), hearing loss (P = 0.02), dizziness (P = 0.006), and headache (P = 0.007), compared with the bilateral SSCD cohorts. Among patients with bilateral disease, those with unilateral surgery reported greater symptomatic resolution with respect to hyperacusis (P = 0.03), hearing loss (P = 0.02), dizziness (P = 0.03), and disequilibrium (P < 0.001), than those with bilateral operations. CONCLUSIONS Surgical management of SSCD leads to high rates of postoperative symptomatic improvement. Patients with unilateral SSCD benefit greater symptomatic resolution compared to those with bilateral pathology.
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Affiliation(s)
- Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Shelby L Willis
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Ansley Unterberger
- 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
| | - Michelle Hong
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Russell De Jong
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Mahlet Mekonnen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Michael Johanis
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Tyler Miao
- Department of Head and Neck Surgery, 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; David Geffen School of Medicine, 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; 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-UCLA Medical Center, University of California, Los Angeles, California, USA.
| | - Quinton Gopen
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
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22
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Lin KF, Bojrab DI, Fritz CG, Vandieren A, Babu SC. Hearing Outcomes After Surgical Manipulation of the Membranous Labyrinth During Superior Semicircular Canal Dehiscence Plugging or Posterior Semicircular Canal Occlusion. Otol Neurotol 2021; 42:806-814. [PMID: 33710144 DOI: 10.1097/mao.0000000000003100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze audiometric data after surgical manipulation of the membranous labyrinth during plugging of superior semicircular canal dehiscence (SSCD) or posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Patients undergoing plugging of SSCD or PSCO between 2009 and 2019. MAIN OUTCOME MEASURES Pre- and postoperative audiometric data were collected per AAO-HNS guidelines. Hearing outcomes at initial and last follow-up were compared. Subanalyses were performed for surgical approach and age. RESULTS Eighty-seven total procedures in 76 patients including 43 middle cranial fossa for SSCD, 29 transmastoid SSCD, and 15 PSCO. Mean preoperative air-conduction-pure-tone averages was 21.1±14.9 dB compared with 26.1 ± 19.6 dB at initial follow-up and 24.4 ± 18.6 dB at last follow-up (p = 0.006). Mean preoperative bone-conduction-pure-tone average was 14.3 ± 11.9 dB compared with 18.3 ± 15.6 dB at initial follow-up and 18.5 ± 16.9 dB at last follow-up (p < 0.001). There were five cases of hearing loss >20 dB including one case of profound sensorineural hearing loss >55 dB. PSCO resulted in the most hearing loss at initial follow-up but largely resolves with time. Transmastoid approaches for SSCD resulted in more hearing loss compared with middle cranial fossa. Hearing outcomes were generally stable for SSCD approaches but showed improvement over time for PSCO. Age >50 was associated with greater hearing loss of 5.2 ± 11.1 dB compared with 1.3 ± 10.5 dB but did not reach statistical significance (p = 0.110). CONCLUSIONS Surgical manipulation of the membranous labyrinth results in statistically significant hearing loss in a pooled analysis. Transient hearing loss is observed in PSCO and TM SSCD plugging was associated with postoperative hearing loss. There was a trend toward increased hearing loss in patients >50 years old.
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Affiliation(s)
- Kenny F Lin
- Michigan Ear Institute, Farmington Hills, Michigan
- Houston Methodist Hospital, Houston, Texas
| | | | - Christian G Fritz
- Michigan Ear Institute, Farmington Hills, Michigan
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
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23
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Tames HLVC, Padula M, Sarpi MO, Gomes RLE, Toyama C, Murakoshi RW, Olivetti BC, Gebrim EMMS. Postoperative Imaging of the Temporal Bone. Radiographics 2021; 41:858-875. [PMID: 33739892 DOI: 10.1148/rg.2021200126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The anatomy of the temporal bone is complex, and postoperative imaging evaluation of this bone can be challenging. Surgical approaches to the temporal bone can be categorized didactically into tympanoplasty and ossicular reconstruction, mastoidectomy, and approaches to the cerebellopontine angle and internal auditory canal (IAC). In clinical practice, different approaches can be combined for greater surgical exposure. Postoperative imaging may be required for follow-up of neoplastic lesions and to evaluate unexpected outcomes or complications of surgery. CT is the preferred modality for assessing the continuity of the reconstructed conductive mechanism, from the tympanic membrane to the oval window, with use of grafts or prostheses. It is also used to evaluate aeration of the tympanic and mastoid surgical cavities, as well as the integrity of the labyrinth, ossicular chain, and tegmen. MRI is excellent for evaluation of soft tissue. Use of a contrast-enhanced fat-suppressed MRI sequence is optimal for follow-up after IAC procedures. Non-echo-planar diffusion-weighted imaging is optimal for detection of residual or recurrent cholesteatoma. The expected imaging findings and complications of the most commonly performed surgeries involving the temporal bone are summarized in this review. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hugo L V C Tames
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Mario Padula
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Maíra O Sarpi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Regina L E Gomes
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Carlos Toyama
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Rodrigo W Murakoshi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Bruno C Olivetti
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Eloísa M M S Gebrim
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
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24
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Panda A, Carlson ML, Diehn FE, Lane JI. Beyond Tympanomastoidectomy: A Review of Less Common Postoperative Temporal Bone CT Findings. AJNR Am J Neuroradiol 2021; 42:12-21. [PMID: 33184072 PMCID: PMC7814786 DOI: 10.3174/ajnr.a6802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/18/2020] [Indexed: 11/07/2022]
Abstract
Postoperative temporal bone imaging after surgical procedures such as ossiculoplasty, tympanomastoidectomy, cochlear implantation, and vestibular schwannoma resection is often encountered in clinical neuroradiology practice. Less common otologic procedures can present diagnostic dilemmas, particularly if access to prior operative reports is not possible. Lack of familiarity with the less common surgical procedures and expected postoperative changes may render radiologic interpretation challenging. This review illustrates key imaging findings after surgery for Ménière disease, superior semicircular canal dehiscence, temporal encephalocele repairs, internal auditory canal decompression, active middle ear implants, jugular bulb and sigmoid sinus dehiscence repair, and petrous apicectomy.
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Affiliation(s)
- A Panda
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
| | - J I Lane
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
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25
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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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26
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Tran ED, Swanson A, Sharon JD, Vaisbuch Y, Blevins NH, Fitzgerald MB, Steenerson KK. Ocular Vestibular-Evoked Myogenic Potential Amplitudes Elicited at 4 kHz Optimize Detection of Superior Semicircular Canal Dehiscence. Front Neurol 2020; 11:879. [PMID: 32982915 PMCID: PMC7477389 DOI: 10.3389/fneur.2020.00879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction: High-resolution temporal bone computed tomography (CT) is considered the gold standard for diagnosing superior semicircular canal dehiscence (SCD). However, CT has been shown over-detect SCD and provide results that may not align with patient-reported symptoms. Ocular vestibular-evoked myogenic potentials (oVEMPs)—most commonly conducted at 500 Hz stimulation—are increasingly used to support the diagnosis and management of SCD. Previous research reported that stimulation at higher frequencies such as 4 kHz can have near-perfect sensitivity and specificity in detecting radiographic SCD. With a larger cohort, we seek to understand the sensitivity and specificity of 4 kHz oVEMPs for detecting clinically significant SCD, as well as subgroups of radiographic, symptomatic, and surgical SCD. We also investigate whether assessing the 4 kHz oVEMP n10-p15 amplitude rather than the binary n10 response alone would optimize the detection of SCD. Methods: We conducted a cross-sectional study of patients who have undergone oVEMP testing at 4 kHz. Using the diagnostic criteria proposed by Ward et al., patients were determined to have SCD if dehiscence was confirmed on temporal bone CT by two reviewers, patient-reported characteristic symptoms, and if they had at least one positive vestibular or audiometric test suggestive of SCD. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal 4 kHz oVEMP amplitude cut-off. Comparison of 4 kHz oVEMP amplitude across radiographic, symptomatic, and surgical SCD subgroups was conducted using the Mann-Whitney U test. Results: Nine hundred two patients (n, ears = 1,804) underwent 4 kHz oVEMP testing. After evaluating 150 temporal bone CTs, we identified 49 patients (n, ears = 61) who had radiographic SCD. Of those, 33 patients (n, ears = 37) were determined to have clinically significant SCD. For this study cohort, 4 kHz oVEMP responses had a sensitivity of 86.5% and a specificity of 87.8%. ROC analysis demonstrated that accounting for the inter-amplitude of 4 kHz oVEMP was more accurate in detecting SCD than the presence of n10 response alone (AUC 91 vs. 87%). Additionally, using an amplitude cut-off of 15uV reduces false positive results and improves specificity to 96.8%. Assessing 4 kHz oVEMP response across SCD subgroups demonstrated that surgical and symptomatic SCD cases had significantly higher amplitudes, while radiographic SCD cases without characteristic symptoms had similar amplitudes compared to cases without evidence of SCD. Conclusion: Our results suggest that accounting for 4 kHz oVEMP amplitude can improve detection of SCD compared to the binary presence of n10 response. The 4 kHz oVEMP amplitude cut-off that maximizes sensitivity and specificity for our cohort is 15 uV. Our results also suggest that 4 kHz oVEMP amplitudes align better with symptomatic SCD cases compared to cases in which there is radiographic SCD but no characteristic symptoms.
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Affiliation(s)
- Emma D Tran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Austin Swanson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew B Fitzgerald
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Kristen K Steenerson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
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27
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Ray A, Hautefort C, Guichard JP, Horion J, Herman P, Kania R, Houdart E, Verillaud B, Vitaux H, Attyé A, Eliezer M. MRI contribution for the detection of endolymphatic hydrops in patients with superior canal dehiscence syndrome. Eur Arch Otorhinolaryngol 2020; 278:2229-2238. [DOI: 10.1007/s00405-020-06282-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
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28
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Validating the Utility of High Frequency Ocular Vestibular Evoked Myogenic Potential Testing in the Diagnosis of Superior Semicircular Canal Dehiscence. Otol Neurotol 2020; 40:1353-1358. [PMID: 31725592 DOI: 10.1097/mao.0000000000002388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ocular vestibular evoked myogenic potential (oVEMP) is a diagnostic test employed in the evaluation of superior semicircular canal dehiscence (SSCD) syndrome. Previous work showed that the presence of the n10 component of oVEMP at 4000 Hz was diagnostic of SSCD with perfect sensitivity and specificity of 1.0 in a series of 22 patients. This study sought to validate the diagnostic accuracy of high-frequency oVEMP with comparison to 500 Hz oVEMP and cervical vestibular evoked myogenic potential (cVEMP) in a larger series of patients. METHODS Retrospective chart review of 171 patients with clinical symptoms consistent with SSCD who underwent oVEMP and cVEMP testing. Dehiscence of the superior semicircular canal (SCC) on high-resolution computed tomography (CT) imaging of the temporal bone was used to identify cases of likely SSCD. The presence or absence of 4000 Hz oVEMP n10 responses, increased amplitude of 500 Hz oVEMP responses, and reduced threshold of 500 Hz cVEMP responses were identified for each patient. RESULTS SCC dehiscence was identified by CT imaging in 48 of 171 patients with symptoms consistent with SSCD. High-frequency oVEMP testing at 4000 Hz elicited a n10 response in 40 of 48 (83.3%) of patients and was present in 48 of 171 (28.1%) patients overall. The corresponding sensitivity was 0.83, specificity was 0.93, positive predictive value was 0.83, and negative predictive value was 0.93. oVEMP and cVEMP testing at 500 Hz was less accurate with sensitivity of 0.62 and 0.64, respectively, and specificity of 0.73 and 0.73, respectively. CONCLUSION The presence of a 4000 Hz oVEMP n10 response was predictive of SSC dehiscence on CT imaging among patients with symptoms consistent with SSCD with sensitivity of 0.83, specificity of 0.93, positive predictive value of 0.83, and negative predictive value of 0.93. A negative finding strongly rules out SSCD. High-frequency oVEMP was more accurate than 500 Hz oVEMP or cVEMP.
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29
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Morley JE. Editorial: The Magic of Spells. J Nutr Health Aging 2020; 24:128-131. [PMID: 32003400 DOI: 10.1007/s12603-020-1322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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30
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Pressure Transmission to the Inner Ear by Mastoid Palpation After Transmastoid Surgery for Superior Canal Dehiscence. Otol Neurotol 2019; 40:e925-e927. [DOI: 10.1097/mao.0000000000002372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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31
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Schwartz SR, Almosnino G, Noonan KY, Banakis Hartl RM, Zeitler DM, Saunders JE, Cass SP. Comparison of Transmastoid and Middle Fossa Approaches for Superior Canal Dehiscence Repair: A Multi-institutional Study. Otolaryngol Head Neck Surg 2019; 161:130-136. [PMID: 30832543 PMCID: PMC11337948 DOI: 10.1177/0194599819835173] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/12/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates. STUDY DESIGN Multicenter retrospective comparative cohort study. SETTINGS Three tertiary neurotology centers. SUBJECTS AND METHODS All adult patients undergoing repair for superior canal dehiscence between 2006 and 2017 at 3 neurotology centers were included. Demographics and otologic history collected by chart review. Imaging, audiometric data, and vestibular evoked myogenic potential measurements were also collected for analysis. RESULTS A total of 68 patients (74 ears) were included in the study. Twenty-one patients underwent middle fossa craniotomy repair (mean age, 47.9 years), and 47 underwent transmastoid repair (mean age, 48.0 years). There were no significant differences in age or sex distribution between the groups. The transmastoid group experienced a significantly shorter duration of hospitalization and lower recurrence rate as compared with the middle fossa craniotomy group (3.8% vs 33%). Both groups experienced improvement in noise-induced vertigo, autophony, pulsatile tinnitus, and nonspecific vertigo. There was no significant difference among symptom resolution between groups. Additionally, there was no significant difference in audiometric outcomes between the groups. CONCLUSION Both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach.
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Affiliation(s)
- Seth R. Schwartz
- Department of Otolaryngology/Head and Neck Surgery, Section of Otology/Neurotology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Galit Almosnino
- Department of Otolaryngology/Head and Neck Surgery, Section of Otology/Neurotology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kathryn Y. Noonan
- Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Renee M. Banakis Hartl
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M. Zeitler
- Department of Otolaryngology/Head and Neck Surgery, Section of Otology/Neurotology, Virginia Mason Medical Center, Seattle, WA, USA
| | - James E. Saunders
- Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephen P. Cass
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
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32
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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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Berning AW, Arani K, Branstetter BF. Prevalence of Superior Semicircular Canal Dehiscence on High-Resolution CT Imaging in Patients without Vestibular or Auditory Abnormalities. AJNR Am J Neuroradiol 2019; 40:709-712. [PMID: 30819770 DOI: 10.3174/ajnr.a5999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/28/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prior studies of radiologic superior semicircular canal dehiscence have suggested that CT may overcall dehiscence. However, many of those studies were performed before the advent of multichannel helical CT. Furthermore, there are limited data investigating the prevalence of radiologic superior semicircular canal dehiscence in asymptomatic individuals. The purpose of this study was to determine the rate of radiologic superior semicircular canal dehiscence in an asymptomatic population using 64-channel helical CT. MATERIALS AND METHODS We retrospectively enrolled 500 consecutive adult patients without symptoms of superior semicircular canal dehiscence who had undergone CT of the temporal bones in the emergency department of a tertiary academic center between February 2012 and June 2017. The superior semicircular canals were evaluated bilaterally by 2 dedicated head and neck radiologists and subjectively classified as either dehiscent or nondehiscent. A secondary group of 110 scans of patients with symptoms consistent with superior semicircular canal dehiscence was similarly interpreted, and the rate of radiologic superior semicircular canal dehiscence was calculated for each group. RESULTS Ten of the 500 asymptomatic patients (2.0%; 95% CI, 1.1%-3.6%) had CT evidence of superior semicircular canal dehiscence, compared with 15 of 110 symptomatic patients (13.6%; 95% CI, 7.8%-21.5%). There was excellent interobserver agreement (κ = 0.91). CONCLUSIONS Only 2% of asymptomatic patients had radiologic evidence of superior semicircular canal dehiscence on 64-detector row helical CT. This is markedly lower than previous reports and approaches the postmortem rate of asymptomatic superior semicircular canal dehiscence. We therefore recommend that asymptomatic patients with CT evidence of superior semicircular canal dehiscence undergo audiologic evaluation because the rate of false-positive scans is extremely low.
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Affiliation(s)
- A W Berning
- From the University of Pittsburgh School of Medicine (A.W.B.)
| | - K Arani
- Departments of Radiology (K.A., B.F.B.)
| | - B F Branstetter
- Departments of Radiology (K.A., B.F.B.).,Otolaryngology (B.F.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Demir E, Afacan NN, Celiker M, Celiker FB, İnecikli MF, Terzi S, Dursun E. Can Wideband Tympanometry Be Used as a Screening Test for Superior Semicircular Canal Dehiscence? Clin Exp Otorhinolaryngol 2018; 12:249-254. [PMID: 30458602 PMCID: PMC6635713 DOI: 10.21053/ceo.2018.01137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We explored whether wideband tympanometry (WBT) could be used as a screening test for superior semicircular canal dehiscence (SSCD), and obtained new WBT data (given that the test is not yet in common clinical use) on patients with SSCD. METHODS We compared the WBT data of patients clinically and radiologically diagnosed with SSCD in our hospital between 2013 and 2018 to those of healthy volunteers. We compared the resonance frequency (RF), maximum absorbance frequency (MAF), and maximum absorbance ratio (MAR). The t-test was used for statistical analysis with the significance level set to P<0.05. In addition, we used receiver operating characteristic analysis to derive cutoff values for SSCD diagnosis in terms of sensitivity and specificity. RESULTS Seventeen patients (four with bilateral and 13 with unilateral disease; 17 ears) diagnosed with SSCD and 27 healthy volunteers (47 ears) were included. The mean RFs of the SSCD patients and healthy subjects were 548.7 Hz (range, 243 to 853 Hz) and 935.1 Hz (range, 239 to 1,875 Hz), respectively (P<0.001). The mean MARs of the SSCD patients and healthy subjects were 89.4% (range, 62% to 100%) and 82.4% (range, 63% to 99%), respectively (P=0.005). The mean MAFs of the SSCD patients and healthy subjects were 1,706.3 Hz (range, 613 to 3,816 Hz) and 2,668 Hz (range, 876 to 4,387 Hz), respectively (P<0.001). In terms of SSCD diagnosis, a MAR above 86% afforded 81% sensitivity and 77% specificity; an RF below 728 Hz, 86% sensitivity and 81% specificity; and an MAF below 1,835 Hz, 79% sensitivity and 67% specificity. CONCLUSION WBT may be a useful clinical screening test for SSCD. The RF and MAF were lower, and the MAR higher, in SSCD patients than in normal controls.
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Affiliation(s)
- Emine Demir
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Nazife Nur Afacan
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Metin Celiker
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Fatma Beyazal Celiker
- Department of Radiology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Mehmet Fatih İnecikli
- Department of Radiology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Suat Terzi
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Engin Dursun
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
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