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Plute T, Abou-Al-Shaar H, Alarifi N, Patel A, Mallela AN, Baddour K, Zenonos GA, McCall AA, Gardner PA. Evaluation of clinical predictors of postoperative outcomes in tegmen defect patients with and without concurrent superior semicircular canal dehiscence and cerebrospinal fluid leak. Am J Otolaryngol 2024; 45:104317. [PMID: 38729011 DOI: 10.1016/j.amjoto.2024.104317] [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: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES Tegmen and superior semicircular canal defects have been well studied, yet the factors contributing to their onset and progression are widely debated. The clinical utility of intraoperative intracranial pressure measurements has yet to be tested. This report aims to use intraoperative opening pressure and concurrent superior semicircular canal dehiscence (SSCD) to analyze factors influencing disease course and clinical outcomes in patients with tegmen dehiscence. METHODS A retrospective analysis of 61 patients who underwent tegmen defect repair was performed. Multiple variables of interest including body mass index (BMI), presence of SSCD, presence of dural venous sinus stenosis, opening pressure, and acetazolamide therapy use were recorded. The cohort was divided into those with or without concurrent SSCD and those presenting with or without cerebrospinal fluid (CSF) leak for analysis. RESULTS A linear relationship between opening pressure and BMI (p = 0.009) was noted; however, intraoperative opening pressure was not associated with disease outcome. Concurrent SSCD was present in 25 % of patients, while 62 % presented with CSF leak. The concurrent SSCD group exhibited higher opening pressure, higher likelihood of having dural sinus stenosis, and higher likelihood of being discharged on acetazolamide. The CSF leak group had higher likelihood of obstructive sleep apnea and persistent symptoms. CONCLUSIONS In patients undergoing tegmen defect repair, concurrent SSCD suggests increased disease severity. The presence of preoperative CSF leak predicts persistent symptoms following repair. BMI is linearly correlated with intracranial pressure in these patients.
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Affiliation(s)
- Tritan Plute
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Norah Alarifi
- Department of Neurological Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Aneek Patel
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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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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Xu XD, Gao N, Yu J, Chen BJ, Chen ZC, Ren DD, Zhang Q, Fang R, Luo HP. The correlation between the body shape and otolithic function in patients with obstructive sleep apnea. Sleep Med 2022; 100:112-119. [PMID: 36041379 DOI: 10.1016/j.sleep.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify the typical pattern of changes of vestibular-evoked myogenic potentials (VEMPs) and explore the relationship between VEMPs and the anthropometry factors in patients with obstructive sleep apnea (OSA). METHODS Patients diagnosed as OSA after overnight polysomnography (PSG) tests were enrolled as the study group. Healthy volunteers were recruited as the control group. Anthropometry data of the body shape and VEMPs results were collected completely. The correlation analysis was conducted among those parameters. RESULTS Forty-nine patients with OSA who were diagnosed in the Therapy Center of Sleep-disordered Breathing in our hospital and sex- and age-matched healthy controls as well. Significant changes in ocular and cervical VEMPs (oVEMP and cVEMP) in the study group were observed, which were reduced response rates, elevated thresholds, decreased amplitudes, and prolonged first wave latencies. In oVEMP, the first wave (n1) latency was significantly correlated with weight, body mass index (BMI), neck circumference, waist circumference, hip circumference, and apnea hypopnea index (AHI). In a tentative application, combined use of BMI and oVEMP n1 latency increased the detection rate during OSA screening prior to PSG. CONCLUSION OSA can negatively affect function of otolithic organs and their pathways. The first wave latency of the VEMPs waveform may be another important parameter to define peripheral nervous system lesions caused by systemic diseases as OSA.
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Affiliation(s)
- Xin-Da Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Na Gao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Jing Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Bin-Jun Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Zi-Chen Chen
- Department of Otorhinolaryngology Head and Neck Surgery, XinHua Hospital, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Dong-Dong Ren
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, 200031, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, XinHua Hospital, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Rui Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; The Therapy Center of Sleep-disordered Breathing, Eye & ENT Hospital, Fudan University, Shanghai, 201112, China.
| | - Hui-Ping Luo
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; The Therapy Center of Sleep-disordered Breathing, Eye & ENT Hospital, Fudan University, Shanghai, 201112, China.
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Kaufman AC, Cooperman S, Ali NES, Alyono JC. Matched Cohort Study of Radiographic Superior Semicircular Canal Dehiscence and Tegmen Dehiscence and Obstructive Sleep Apnea. Otol Neurotol 2022; 43:1222-1226. [PMID: 36214499 DOI: 10.1097/mao.0000000000003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA). STUDY DESIGN Retrospective matched cohort study. SETTING Tertiary care center. PATIENTS Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded. MAIN OUTCOME MEASURES Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers. RESULTS The average body mass index of the OSA patients was 29.2 kg/m 2 with an average apnea-hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m 2 . Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group ( p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group ( p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence. CONCLUSION The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from age- and sex-matched controls. This is in contrast to a previous case-control study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.
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Affiliation(s)
- Adam C Kaufman
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
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Cocca S, Mignacco G, Mandalà M, Giannitto C, Esposito AA, Porcino S. A “Double” Third Window Syndrome: The Case of Semicircular Canal Dehiscence in Twin Sisters. REPORTS IN MEDICAL IMAGING 2022. [DOI: 10.2147/rmi.s333347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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7
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Superior semicircular canal dehiscence: a narrative review. The Journal of Laryngology & Otology 2021; 136:284-292. [PMID: 34615564 DOI: 10.1017/s0022215121002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mozaffari K, Ghodrati F, Pradhan A, Ng E, Ding K, Rana S, Duong C, Anderson RN, Enomoto A, Sheppard JP, Sun MZ, Phillips HW, Yang I, Gopen Q. Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience. World Neurosurg 2021; 156:e408-e414. [PMID: 34583007 DOI: 10.1016/j.wneu.2021.09.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an abnormality of the otic capsule, which normally overlies the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. Given the complexity of the disease, there are patients who experience less favorable surgical outcomes and require revision surgery. The purpose of this study was to report to the rate of postoperative symptomatic improvement in patients who required revision surgery. METHODS A retrospective analysis of patients undergoing SSCD surgical repair at a single institution was performed. Information on patient demographics, primary and secondary surgical approaches, surgical outcomes, and follow-up length was collected. RESULTS Seventeen patients underwent 20 revision surgeries. There were eleven (65%) females and six (35%) males. Mean age of the cohorts was 50 years (range 30-68 years), and mean follow-up length was 6.8 months (range 0.1-31.1 months). Cerebrospinal fluid leak was noted in 67% of cases. The greatest postoperative symptomatic resolution was reported in oscillopsia (100%), headache (100%), and internal sound amplification (71%), while the least postoperative symptomatic resolution was reported in tinnitus (42%), aural fullness (40%), and dizziness (29%). CONCLUSIONS Revision surgery can provide symptomatic improvement in select SSCD patients; however, patients should be cautioned about the possibility of less favorable outcomes than in index surgery. Revision surgeries are associated with a considerably higher rate of perioperative cerebrospinal fluid leak.
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Affiliation(s)
- Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Farinaz Ghodrati
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Anjali Pradhan
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Kevin Ding
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Shivam Rana
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Roan N Anderson
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Adam Enomoto
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - H Westley Phillips
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
| | - Quinton Gopen
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
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Berkiten G, Gürbüz D, Akan O, Tutar B, Tunç MK, Karaketir S, Bircan HS, Berkiten E, Sarı H, Atar Y, Uyar Y. Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension. Eur Arch Otorhinolaryngol 2021; 279:2899-2904. [PMID: 34424380 DOI: 10.1007/s00405-021-07020-z] [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: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES The objective of the study is to evaluate a relationship between idiopathic intracranial hypertension (IIH) and superior semicircular canal dehiscence (SSCD) of bone overlying the superior semicircular canal (SSC). MATERIALS AND METHODS A total of 57 (114 ears) individuals, 20 of whom were controls and 37 of whom were IIH, were included in the study. Individuals were evaluated with 0.8 mm slice thickness computed tomography (CT) images for SSC bony roof thickness and SSCD. Thickness of the bony roof over the SSC was graded from Grade 1 to Grade 4. Grade 3 was defined as pre-dehiscence and Grade 4 as dehiscence. RESULTS Bony roof thickness was 1.25 mm in the control group and 0.76 mm in the IIH group. When bony roof thickness was compared between the groups, it was found to be significantly thinner in the IIH group (p = 0.012). In the IIH group, while dehiscence was detected in 25 of 74 ears, no dehiscence was detected in 49 ears. In the control group, while dehiscence was detected in 5 ears, no dehiscence was detected in 35 ears. The difference is statistically significant (p = 0.015). The correlation between bony roof thickness and cerebrospinal fluid (CSF) pressure in the IIH group was not statistically significant (p = 0.343; rho = 0.110). The correlation between bony roof thickness and age in the IIH group was not statistically significant (p = 0.082; rho = - 0.164). CONCLUSION Increased CSF pressure in patients with IIH may cause chronic, progressive, and irreversible damage to the bone of the SSC and, according to our study, the rate of SSCD was found to be high in IIH patients.
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Affiliation(s)
- Güler Berkiten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey.
| | - Defne Gürbüz
- Department of Radiology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Onur Akan
- Department of Neurology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Belgin Tutar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Melis Koşar Tunç
- Department of Radiology, Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Semih Karaketir
- Department of Otorhinolaryngology-Head and Neck Surgery, Bulanik State Hospital, Muş, Istanbul, Turkey
| | - Hasan Sami Bircan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Ertan Berkiten
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Hüseyin Sarı
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Yavuz Atar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology-Head and Neck Surgery, University Health of Sciences Prof. Dr. Cemil Taşçioğlu Training and Research Hospital Hospital, Darulaceze Cad. No: 25 Okmeydani, Sisli/Istanbul, Turkey
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Guo H, Zhang Y, Han T, Cui X, Lu X. Chronic intermittent hypoxia aggravates skeletal muscle aging by down-regulating Klc1/grx1 expression via Wnt/β-catenin pathway. Arch Gerontol Geriatr 2021; 96:104460. [PMID: 34218156 DOI: 10.1016/j.archger.2021.104460] [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: 03/22/2021] [Revised: 05/23/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sleep breathing disorder may affect skeletal muscle decline in the elderly, but the mechanism is not clear. Therefore, this study explores the mechanism of skeletal muscle aging in chronic intermittent hypoxia (CIH) rats. METHODS In vitro and in vivo CIH models were constructed in L6 cells and SD rats by treating chronic intermittent hypoxia. Pathological changes of skeletal muscle in vivo were measured by hematoxylin-eosin (HE) staining. Cell proliferation and apoptosis were detected by CCK-8 and Flow cytometer, respectively. The expression of KLC1/GRX1 and the proteins related to the Wnt/β-catenin pathway were measured by qRT-PCR and western blot. RESULTS CIH model was successfully established induced by chronic intermittent hypoxia with lower skeletal muscle index (SMI), increased inward migration of muscle fiber cell nucleus, and muscle cells' distance. The results showed that Wnt/β-catenin signalling was activatedin both L6 cells and CIH rats' model. KLC1 and GRX1 were significantly downregulated in the CIH model. Loss of function showed that downregulation of KLC1 promoted L6 cell and skeletal muscle aging in vitro and in vivo, respectively. CONCLUSION Our results demonstrated that CIH aggravated skeletal muscle aging by down-regulating KLC1/GRX1 expression via the Wnt/β-catenin pathway.
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Affiliation(s)
- Hua Guo
- Department of Geriatrics, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China; Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Yunyun Zhang
- Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Tingting Han
- Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Xiaochuan Cui
- Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China.
| | - Xiang Lu
- Department of Geriatrics, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
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Bhatt AA, Lundy LB, Middlebrooks EH, Vibhute P, Gupta V, Rhyner PA. Superior Semicircular Canal Dehiscence : Covering Defects in Understanding from Clinical to Radiologic Evaluation. Clin Neuroradiol 2021; 31:933-941. [PMID: 34097081 DOI: 10.1007/s00062-021-01037-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Superior semicircular canal dehiscence alters the normal fluid mechanics of the vestibulocochlear system and can be a debilitating condition. This article reviews the current understanding of the bony labyrinthine defect, including symptoms, etiology, surgical approach, as well as preoperative and postoperative imaging pearls.
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Affiliation(s)
- Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA.
| | - Larry B Lundy
- Department of Otolaryngology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Patricia A Rhyner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
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Chari DA, Juliano AF, Jung DH. Radiologically-proven New Development of Superior Semicircular Canal Dehiscence Associated With Development of Superior Semicircular Canal Dehiscence Syndrome. Otol Neurotol 2021; 42:285-289. [PMID: 33273305 DOI: 10.1097/mao.0000000000002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This report describes a case of development of radiologic superior semicircular canal dehiscence and reviews the literature for pertinent clinical and radiologic findings in patients with superior semicircular canal dehiscence syndrome (SCDS). PATIENT A 28-year-old man presented with auditory and vestibular symptoms of SCDS and underwent a high-resolution temporal bone computed tomography scan that showed frank dehiscence of the right superior semicircular canal. Diagnosis of SCDS was further verified with audiometric and cervical vestibular-evoked myogenic potential (cVEMP) thresholds. The patient had previously undergone a computed tomography scan 12 years prior for work-up of sudden sensorineural hearing loss that showed no evidence of superior semicircular canal dehiscence bilaterally. INTERVENTIONS A combination of diagnostic and therapeutic interventions was conducted consisting of preoperative audiometric and cVEMP thresholds, followed by middle fossa craniotomy for surgical repair of the dehiscence. MAIN OUTCOME MEASURE Postoperative audiometric and cVEMP thresholds and symptomatic improvement of SCDS after surgical repair of the dehiscence. RESULTS The patient reported resolution of his clinical symptoms after surgical repair of the dehiscence. Postoperative cVEMP thresholds improved to the normal range and the mild low-frequency conductive hearing loss resolved. CONCLUSIONS To our knowledge, this case report is the first description of radiologically proven new development of superior canal dehiscence. Further prospective studies that include serial imaging examinations may help with visualizing and understanding the temporal evolution of superior canal dehiscence, and better elucidate the relationship between development/ progression of superior canal dehiscence and onset of clinical symptoms.
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Affiliation(s)
- Divya A Chari
- Department of Otolaryngology - Head and Neck Surgery
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - David H Jung
- Department of Otolaryngology - Head and Neck Surgery
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Eberhard KE, Chari DA, Nakajima HH, Klokker M, Cayé-Thomasen P, Lee DJ. Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome. Front Neurol 2021; 12:638574. [PMID: 33889125 PMCID: PMC8055857 DOI: 10.3389/fneur.2021.638574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Divya A. Chari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Hideko Heidi Nakajima
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Mads Klokker
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
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Examination of the possible relation of the superior semicircular canal morphology with the roof thickness of the glenoid fossa and bone changes of the temporomandibular joint. Eur Arch Otorhinolaryngol 2020; 277:3423-3430. [DOI: 10.1007/s00405-020-06063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
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Sarna B, Abouzari M, Merna C, Jamshidi S, Saber T, Djalilian HR. Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment. Front Neurol 2020; 11:1046. [PMID: 33041986 PMCID: PMC7522398 DOI: 10.3389/fneur.2020.01046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
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Affiliation(s)
- Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Shahrnaz Jamshidi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Tina Saber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, CA, United States
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The Prevalence of Superior Semicircular Canal Dehiscence in Patients With Mastoid Encephalocele or Cerebrospinal Fluid Otorrhea. Otol Neurotol 2020; 40:485-490. [PMID: 30870362 DOI: 10.1097/mao.0000000000002155] [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
OBJECTIVE To evaluate the association between mastoid encephalocele or cerebrospinal fluid (CSF) otorrhea and concurrent superior semicircular canal dehiscence (SSCD). STUDY DESIGN Retrospective case-control study with chart and imaging review. SETTING University-affiliated tertiary referral center. PATIENTS A chart review was conducted of all patients greater than 18 years of age who had primary surgery for CSF otorrhea or encephalocele at our university-affiliated tertiary center from 2000 to 2016. Eighty-three patients matched inclusion criteria for case subjects, and 100 patients without CSF otorrhea or encephalocele were included for controls. MAIN OUTCOME MEASURE High-resolution computed tomography (CT) scans were reviewed to assess superior semicircular canal roof integrity. Student's t test was used to determine significance of continuous variables. Odds ratio (OR) and χ test was used to determine the association between SSCD and concurrent mastoid encephalocele or CSF otorrhea compared with the control population. RESULTS The mean age of the 83 case subjects was 54 years, and 73% were women. In patients with confirmed encephalocele and CSF otorrhea, the prevalence of SSCD was 35%, which was significantly greater than controls (2%) (OR = 26.1, p < 0.001). In patients with only CSF otorrhea, 21% had concurrent SSCD (OR = 10.3, p = 0.001). In patients with SSCD, 46% had bilateral canal dehiscence. CONCLUSIONS This is the largest study to evaluate the prevalence of SSCD in patients with concurrent mastoid encephalocele. This study showed a significant association between SSCD and the presence of both mastoid encephalocele and CSF otorrhea. This data suggests that surgeons should have a high suspicion for SSCD in patients presenting with encephalocele or CSF otorrhea.
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Luryi AL, Babu S, Michaelides EM, Kveton JF, Bojrab DI, Schutt CA. Association Between Body Mass Index and Complications in Acoustic Neuroma Surgery. Otolaryngol Head Neck Surg 2020; 162:538-543. [DOI: 10.1177/0194599820906400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives Elevated body mass index (BMI) is a risk factor for surgical complications, but data in acoustic neuroma surgery are conflicting and limited to small single-institution studies. This work evaluates associations between BMI and complications in surgery for acoustic neuroma (AN). Study Design Retrospective review. Setting: Two tertiary otology referral institutions. Subjects and Methods Patients undergoing surgery for AN. Univariate and multivariate analysis of association between BMI and complications was performed using two-tailed t tests and binary logistic regression. Results BMI ranged from 18.0 kg/m2 to 63.9 kg/m2 with mean of 29.2 kg/m2 among 362 included patients. High BMI was associated with increased risk of cerebrospinal fluid (CSF) leak ( p = 0.003) and need for revision surgery within 6 months ( p = 0.03). CSF leak occurred in 11.6% of obese patients (BMI ≥ 30.0) and 5.1% of patients with BMI < 30.0. There was no association between BMI and post-operative intracranial hemorrhage, wound infection, or incomplete resection ( p > 0.05). Multivariate analysis revealed BMI was associated with CSF leak (odds ratio 1.11 per BMI point, p = 0.002) and need for revision surgery (odds ratio 1.07 per BMI point, p = 0.02) independent of age, gender, tumor size, or surgical approach. Conclusions The largest series to date investigating BMI in acoustic surgery is presented. Elevated BMI is strongly associated with CSF leak and need for revision surgery but not with other complications. Obese or overweight patients undergoing acoustic neuroma resection should be counseled of their increased risk of CSF leak.
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Affiliation(s)
- Alexander L. Luryi
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, Farmington Hills, MI, USA
| | - Elias M. Michaelides
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University, Chicago, IL, USA
| | - John F. Kveton
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Dennis I. Bojrab
- Department of Neurotology, Michigan Ear Institute, Farmington Hills, MI, USA
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Temporal Bone Anatomy in Superior Semicircular Canal Dehiscence: A Case Control Study on Bone Pneumatization and the Level of Middle Cranial Fossa. Otol Neurotol 2020; 41:e334-e341. [DOI: 10.1097/mao.0000000000002522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Coelho DH, Fasulo B, Quinn K, Tang Y, Sima A, Forsthoffer B. Is the Height of the Arcuate Eminence Related to Body Mass Index? Otolaryngol Head Neck Surg 2020; 162:353-358. [PMID: 31959048 DOI: 10.1177/0194599819900342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the relationship, if any, between body mass index (BMI) and attenuation of the arcuate eminence (AE). STUDY DESIGN Case series with chart review. SETTING Tertiary neurotologic referral center. SUBJECTS AND METHODS Submillimeter distances were recorded from high-resolution temporal bone computed tomography (CT) scans of 50 patients (100 sides). The AE (defined as the superiormost location of the petrous bone over the otic capsule), the bony apex of the superior semicircular canal (SSC), and the geniculate ganglion (GG) were identified and 3-dimensional distances measured. The height of the AE relative to the bony apex of the superior semicircular canal was determined using Euclidean geometry using the fixed anatomical landmark of the GG as the origin. Correlations between AE and BMI were calculated using Pearson's, linear mixed effects, and sensitivity analysis models. RESULTS The mean (SD) BMI was 30 (8.1) kg/m2, with 16 (30%) patients falling in the underweight/normal category (BMI <25 kg/m2), 10 (20%) overweight patients (25 kg/m2≤ BMI ≤ 30 kg/m2), and 24 (48%) patients considered obese (BMI >30 kg/m2). The mean (SD) AE heights for the left and right ears were 2.5 (1.11) and 2.6 (1.09), respectively. The results of the linear mixed-effects models indicated little evidence that BMI is associated with AE height when including all patients (partial R2 = 0.040) and when using BMI categories (partial R2 = 0.025). CONCLUSION Contrary to other structures within the lateral skull base, the relative prominence of the arcuate eminence does not correlate with BMI or any other demographic variables.
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Affiliation(s)
- Daniel H Coelho
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Bradley Fasulo
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kevin Quinn
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Yang Tang
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Brielle Forsthoffer
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Voldřich R, Májovský M, Chovanec M, Netuka D. First Case Report of Bilateral Spontaneous Otogenic Pneumocephalus. World Neurosurg 2019; 125:179-182. [DOI: 10.1016/j.wneu.2019.01.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 12/29/2022]
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Superior Canal Dehiscence Involving the Superior Petrosal Sinus: A Novel Classification Scheme. Otol Neurotol 2018; 39:e849-e855. [DOI: 10.1097/mao.0000000000001965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulsatile versus non-pulsatile tinnitus in idiopathic intracranial hypertension. Acta Neurochir (Wien) 2018; 160:2025-2029. [PMID: 30014363 DOI: 10.1007/s00701-018-3587-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Tinnitus is a symptom commonly associated with idiopathic intracranial hypertension (IIH) that can have a profound effect on quality of life. We aim to determine tinnitus symptom response after dural venous sinus stenting (DVSS) or CSF diversion with a shunt, in patients with both pulsatile (PT) and non-pulsatile tinnitus (NPT). METHODS Single-centre cohort of IIH patients (2006-2016) who underwent 24-h ICP monitoring (ICPM). An un-paired t test compared ICP and pulse amplitude (PA) values in IIH patients with PT vs. NPT. RESULTS We identified 59 patients with IIH (56 F:3 M), mean age 32.5 ± 9.49 years, 14 of whom suffered from tinnitus. Of these 14, seven reported PT and seven reported NPT. Patients with tinnitus had a mean 24-h ICP and PA of 9.09 ± 5.25 mmHg and 6.05 ± 1.07 mmHg respectively. All 7 patients with PT showed symptom improvement or resolution after DVSS (n = 4), secondary DVSS (n = 2) or shunting (n = 1). In contrast, of the 7 with NPT, only 1 improved post intervention (DVSS), despite 2 patients having shunts and 5 having DVSS. CONCLUSIONS NPT and PT were equally as common in our group of IIH patients. DVSS appears to be an effective management option for IIH patients with a clear history of pulsatile tinnitus. However, non-pulsatile tinnitus was more persistent and did not respond well to either DVSS or CSF diversion.
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Superior semicircular canal dehiscence: Diagnosis and management. J Clin Neurosci 2018; 48:58-65. [DOI: 10.1016/j.jocn.2017.11.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022]
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Obesity Does Not Increase Operative Time in Otologic Surgery: An Analysis of 5125 Cases. Otol Neurotol 2018; 39:e103-e107. [PMID: 29315184 DOI: 10.1097/mao.0000000000001662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A large shoulder can impact otologic surgical access. The physical obstruction of a large shoulder may force the surgeon to adjust his or her posture or hand position. We sought to assess the effect of body mass index (BMI) on operative time in tympanoplasties and tympanomastoidectomies. STUDY DESIGN Cross-sectional analysis. SETTING National surgical quality improvement program dataset (NSQIP) 2011 to 2014. PATIENTS Current procedural terminology (CPT) codes were used to identify patients undergoing tympanoplasties and tympanomastoidectomies. INTERVENTIONS Otologic surgery as indicated by CPT code. MAIN OUTCOME MEASURES Targeted variables included height, weight, and operative time. BMI was stratified to assess a range of body compositions (<25, 25-30, >30-35, >35-40, >40). Categorical variables were compared using χ tests and continuous variables were compared using Kruskal-Wallis tests. Correlation between operative time and BMI was assessed using Spearman's rho. A generalized linear model was used to analyze the variables affecting operative time. Surgical complications were assessed in binary logistic regression using the enter method. Two-tailed significance was set at α = 0.05. RESULTS Two surgical groups were identified: tympanoplasty (n = 3,508) and tympanomastoidectomy (n = 1,617). There was not a significant difference in mean operative time across the BMI subgroups for either surgical group (p = 0.617, 0.859, respectively). Multivariate analyses showed no significant difference in operative times based on BMI classification. CONCLUSIONS The body habitus of obese patients may force the otologic surgeon to adapt, but obese patients do not have a statistically significant longer mean operative time for tympanoplasties and tympanomastoidectomies than patients with a lower BMI.
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Kamakura T, Nadol Jr. JB. Evidence of Osteoclastic Activity in the Human Temporal Bone. Audiol Neurootol 2017; 22:218-225. [DOI: 10.1159/000481279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/06/2017] [Indexed: 12/25/2022] Open
Abstract
Bone remodeling within the otic capsule has been reported to be inhibited especially at or near the cochlea, except under some pathological conditions such as otosclerosis, Paget's disease, or mastoiditis, when bone remodeling can occur. Microcavitations found in periosteal and endosteal layers of human temporal bone specimens without otosclerosis, Paget's disease, or inflammation as reported in the current study are consistent with osteoclastic bone resorption. Thirty-three temporal bones from 33 patients were prepared for light microscopy and classified into 4 groups: histologically proven dehiscence of the superior semicircular canal (SSCD) (n = 3, group 1), age 20 years or younger (n = 10, group 2), age 90 years or older and with otosclerosis (n = 10, group 3), and age 90 years or older without otosclerosis (n = 10, group 4). Microcavitation was seen at 7 anatomic locations in the temporal bone in all 4 groups, but not in the cochlea or vestibule. Microcavitation within the temporal bone is likely due to osteoclastic activity, and it is seen in both young and old patients, patients with and without otosclerosis, and in cases with SSCD.
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Incidence of Pediatric Superior Semicircular Canal Dehiscence and Inner Ear Anomalies: A Large Multicenter Review. Otol Neurotol 2017; 37:1370-5. [PMID: 27636391 DOI: 10.1097/mao.0000000000001194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the pediatric incidence and association of superior semicircular canal dehiscence (SSCD) with inner ear (IE) anomalies. STUDY DESIGN Retrospective chart review. SETTING Two tertiary referral centers. PATIENTS Children less than 18 years who received a 0.5 mm or less collimated computed tomography study including the temporal bones between 2010 and 2013 for reasons including, but not limited to, hearing loss, trauma, and infection. INTERVENTIONS Images were reformatted into Pöschl and Stenver planes. Five hundred three computed tomography studies (1,006 temporal bones) were reviewed by experienced, blinded neuroradiologists. MAIN OUTCOME MEASURES Incidence of SSCD and IE anomalies. Patient age, sex, and diagnosis were recorded. Statistical analysis was performed to compare outcome measures among patient demographics. RESULTS The incidence of SSCD was 6.2% (31/503) and an IE anomaly was 15.1% (76/503) of individuals. The incidence of SSCD with an IE anomaly was not significantly correlated (1.1%, 40/1,006; p = 0.23; LR = +1.29). The mean age of children with SSCD was lower (5.9 versus 9.8 yr; p = 0.002). SSCD incidence decreased with age (ages <2, 2-8, and 9-18 yr were 36.7%, 5.6%, and 3.2%; p<0.001) and SSC bone thickness nonsignificantly increased with age. Children with SSCD were commonly male (74.2%, p = 0.041). CONCLUSION SSCD and IE anomalies are unlikely related. SSCD incidence is highest in children <2 years, with SSC bone increasing until 2 to 8 years of age. This supports the theory of a congenital precedent to SSCD, with overlying bone maturation occurring during early childhood. Age <2 years was a significant predictor of SSCD.
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Kuo P, Bagwell KA, Mongelluzzo G, Schutt CA, Malhotra A, Khokhar B, Kveton JF. Semicircular canal dehiscence among idiopathic intracranial hypertension patients. Laryngoscope 2017; 128:1196-1199. [PMID: 28833207 DOI: 10.1002/lary.26795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The cause of superior semicircular canal dehiscence (SSCD) is unknown. Because of a demonstrated association with tegmental defects and obesity, some have suggested idiopathic intracranial hypertension (IIH) could contribute by eroding the bone over the canal and resulting in SSCD. However, an association between IIH and SSCD has not previously been evaluated. Our objective was to evaluate an association between IIH and SSCD. STUDY DESIGN Retrospective cohort. METHODS A retrospective study was performed of opening pressures for consecutive patients presenting at a lumbar puncture clinic between August 2012 and October 2015. Imaging for patients who also had thin-sectioned computed tomography (CT) imaging was reviewed for the presence of radiographic SSCD. Association between IIH and SSCD was evaluated using the Student t test and multivariate logistic regression. RESULTS One hundred twenty-one patients had both a lumbar puncture performed and thin-sectioned CT imaging available, of which 24 patients (19.8%) met the criteria for IIH with an opening pressure >25 cm H2 O. The remaining 97 patients (80.2%) did not have elevated opening pressures and served as the control cohort. None of the 24 patients with IIH had radiographic SSCD, whereas eight of the 97 patients (8.2%) without IIH had radiographic SSCD. The average opening pressure in patients without radiographic SSCD was 20.2 cm H2 O compared to 19.3 cm H2 O in patients with radiographic SSCD (P = .521). In multivariate logistic regression controlling for age, body mass index, gender, and comorbidities (hypertension, diabetes, hyperlipidemia), opening pressure was not a significant predictor of radiographic SSCD. CONCLUSIONS The results of this retrospective pilot study do not suggest an association between IIH and SSCD. LEVEL OF EVIDENCE 3b. Laryngoscope, 128:1196-1199, 2018.
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Affiliation(s)
- Phoebe Kuo
- Department of Surgery-Otolaryngology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Kenneth A Bagwell
- Department of Surgery-Otolaryngology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Gino Mongelluzzo
- Department of Radiology, Geisinger Medical Center, Danville, Pennsylvania, U.S.A
| | | | - Ajay Malhotra
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Babar Khokhar
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - John F Kveton
- Department of Surgery-Otolaryngology, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Wackym PA, Mackay-Promitas HT, Demirel S, Gianoli GJ, Gizzi MS, Carter DM, Siker DA. Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis. Laryngoscope Investig Otolaryngol 2017; 2:225-253. [PMID: 29094067 PMCID: PMC5654938 DOI: 10.1002/lio2.89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Patients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors. Study Design Observational analytic case-control study in a tertiary referral center. Methods Twelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms. In addition to one of the neurotologists, 2 neurologists (one specializing in migraine and the other a neuro-ophthalmologist), and a psychologist clinician-investigator completed comprehensive evaluations. Neuropsychology test batteries included: the Millon Behavioral Medicine Diagnostic; Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7); Adverse Childhood Experiences Scale; the Wide Range Assessment of Memory and Learning, including the 3 domains of verbal memory, visual memory, and attention/concentration; Wechsler Adult Intelligence Scale; and the Delis-Kaplan Executive Function System. The control cohort was comprised of 17 participants who previously underwent surgery for third window syndrome that resulted in the expected outcomes of resolution of their third window syndrome symptoms and cognitive dysfunction. Results There was a high rate of psychological comorbidity (n = 6) in the outlier cohort; multiple traumatic brain injuries were also a confounding element (n = 10). One patient had elevated cerebrospinal fluid (CSF) pressure requiring ventriculoperitoneal shunting to control the recurrence of dehiscence and one patient with a drug-induced Parkinson-like syndrome and idiopathic progressive neurological degenerative process. Conclusions Components of the Millon Behavioral Medicine Diagnostic, PHQ-9 and GAD-7 results suggest that these instruments would be useful as screening tools preoperatively to identify psychological comorbidities that could confound outcomes. The identification of these comorbid psychological as well as other neurological degenerative disease processes led to alternate clinical management pathways for these patients. Level of Evidence 2b.
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Affiliation(s)
- P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery Rutgers Robert Wood Johnson Medical School and the Ear and Skull Base Center New Brunswick New Jersey
| | | | | | | | | | | | - David A Siker
- Siker Medical Imaging and Intervention Portland Oregon
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Heidenreich KD, Kileny PR, Ahmed S, El-Kashlan HK, Melendez TL, Basura GJ, Lesperance MM. Superior Canal Dehiscence Syndrome Affecting 3 Families. JAMA Otolaryngol Head Neck Surg 2017; 143:656-662. [PMID: 28384775 DOI: 10.1001/jamaoto.2016.4743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Superior canal dehiscence syndrome (SCDS) is an increasingly recognized cause of hearing loss and vestibular symptoms, but the etiology of this condition remains unknown. Objective To describe 7 cases of SCDS across 3 families. Design, Setting, and Participants This retrospective case series included 7 patients from 3 different families treated at a neurotology clinic at a tertiary academic medical center from 2010 to 2014. Patients were referred by other otolaryngologists or were self-referred. Each patient demonstrated unilateral or bilateral SCDS or near dehiscence. Interventions Clinical evaluation involved body mass index calculation, audiometry, cervical vestibular evoked myogenic potential testing, electrocochleography, and multiplanar computed tomographic (CT) scan of the temporal bones. Zygosity testing was performed on twin siblings. Main Outcomes and Measures The diagnosis of SCDS was made if bone was absent over the superior semicircular canal on 2 consecutive CT images, in addition to 1 physiologic sign consistent with labyrinthine dehiscence. Near dehiscence was defined as absent bone on only 1 CT image but with symptoms and at least 1 physiologic sign of labyrinthine dehiscence. Results A total of 7 patients (5 female and 2 male; age range, 8-49 years) from 3 families underwent evaluation. Family A consisted of 3 adult first-degree relatives, of whom 2 were diagnosed with SCDS and 1 with near dehiscence. Family B included a mother and her child, both of whom were diagnosed with unilateral SCDS. Family C consisted of adult monozygotic twins, each of whom was diagnosed with unilateral SCDS. For all cases, dehiscence was located at the arcuate eminence. Obesity alone did not explain the occurrence of SCDS because 5 of the 7 cases had a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 30.0. Conclusions and Relevance Superior canal dehiscence syndrome is a rare, often unrecognized condition. This report of 3 multiplex families with SCDS provides evidence in support of a potential genetic contribution to the etiology. Symptomatic first-degree relatives of patients diagnosed with SCDS should be offered evaluation to improve detection of this disorder.
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Affiliation(s)
- Katherine D Heidenreich
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Paul R Kileny
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Sameer Ahmed
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Hussam K El-Kashlan
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Tori L Melendez
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Gregory J Basura
- Division of Otology-Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
| | - Marci M Lesperance
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor
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Lagman C, Ong V, Chung LK, Elhajjmoussa L, Fong C, Wang AC, Gopen Q, Yang I. Pediatric superior semicircular canal dehiscence: illustrative case and systematic review. J Neurosurg Pediatr 2017; 20:196-203. [PMID: 28548616 DOI: 10.3171/2017.3.peds1734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study is to present an illustrative case of pediatric superior semicircular canal dehiscence (SSCD) and to systematically review the current published literature in the pediatric population. METHODS An electronic search of the Scopus, Web of Science, PsycINFO, Cochrane, and Embase databases was performed by 2 independent authors through January 2017. Search term combinations included "pediatrics," "children," "canal," and "dehiscence." Inclusion criteria were as follows: English, full-text clinical studies, case reports, and case series describing pediatric patient(s) (younger than 18 years) with CT evidence of SSCD. Baseline patient demographic characteristics, clinical presentations, dehiscence characteristics, management strategies, and outcome data were extracted. RESULTS A total of 14 studies involving 122 patients were included in the quantitative synthesis. The patients' mean age was 7.22 years. Male predominance was observed (approximate male-to-female ratio of 1.65:1). Neurodevelopmental disorders were common (n = 14, 11.5%). Auditory signs and symptoms were more common than vestibular signs and symptoms. Hearing loss (n = 62, 50.8%) was the most common auditory symptom and an indicator for imaging evaluation. Vertigo was the most common vestibular symptom (n = 8, 6.6%). Hearing aids were recommended in 8 cases (6.6%), and surgical repair was performed in 1 case (0.8%). Symptom outcomes and follow-up durations were infrequently reported. CONCLUSIONS The authors' data suggest that in pediatric SSCD, males are more commonly affected than females. This is different than the adult population in which females are predominantly affected. A history of otologic and/or neurodevelopmental abnormalities was common. There was a preponderance of auditory symptoms in this age group. Conservative management was favored in the majority.
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Affiliation(s)
| | | | | | | | | | | | | | - Isaac Yang
- Departments of 1 Neurosurgery.,Radiation Oncology, and.,Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
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Ung N, Chung LK, Lagman C, Bhatt NS, Barnette NE, Ong V, Gopen Q, Yang I. Outcomes of middle fossa craniotomy for the repair of superior semicircular canal dehiscence. J Clin Neurosci 2017. [PMID: 28622893 DOI: 10.1016/j.jocn.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) is a rare defect of the arcuate eminence that causes an abnormal connection between the superior semicircular canal and middle cranial fossa. Patients often present with a variety of auditory and vestibular symptoms. Trigger avoidance is the initial strategy, but surgery may be necessary in debilitating cases. We retrospectively reviewed SSCD patients undergoing repair via a middle fossa craniotomy between March 2011 and September 2015. Forty-nine patients undergoing 58 surgeries were identified. Autophony was the most common symptom at presentation (n=44; 90%). Mean follow-up was 10.9months, with 100% of patients reporting resolution of at least one symptom. Aural fullness was the most commonly resolved symptom following surgical repair (n=19/22; 86%). Hearing loss (n=11/25; 44%) and tinnitus (n=11/38; 29%) were the most common symptoms to persist following surgery. The most common symptom to develop after surgery was disequilibrium (n=4/18; 22%). Upon comparing the overall pre-operative and post-operative groups, the number of patients with autophony (p<0.0001), aural fullness (p=0.0006), hearing loss (p=0.0119), disequilibrium (p=0.0002), sound- and pressure-induced vertigo (p<0.0001), and tinnitus (p<0.0001) were significantly different. Improved clinical outcomes were demonstrated in patients undergoing SSCD repair through a middle cranial fossa approach. The most common presenting symptom (autophony) was also most likely to resolve after surgery. Hearing loss is less amenable to surgical correction. Disequilibrium developed in a small number of patients after repair.
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Affiliation(s)
- Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nikhilesh S Bhatt
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Natalie E Barnette
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Vera Ong
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Quinton Gopen
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States; Department of Head and Neck Surgery, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6901, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States; Department of Head and Neck Surgery, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6901, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States; Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States.
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Ward BK, Carey JP, Minor LB. Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years. Front Neurol 2017; 8:177. [PMID: 28503164 PMCID: PMC5408023 DOI: 10.3389/fneur.2017.00177] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/13/2022] Open
Abstract
Superior semicircular canal dehiscence syndrome was first reported by Lloyd Minor and colleagues in 1998. Patients with a dehiscence in the bone overlying the superior semicircular canal experience symptoms of pressure or sound-induced vertigo, bone conduction hyperacusis, and pulsatile tinnitus. The initial series of patients were diagnosed based on common symptoms, a physical examination finding of eye movements in the plane of the superior semicircular canal when ear canal pressure or loud tones were applied to the ear, and high-resolution computed tomography imaging demonstrating a dehiscence in the bone over the superior semicircular canal. Research productivity directed at understanding better methods for diagnosing and treating this condition has substantially increased over the last two decades. We now have a sound understanding of the pathophysiology of third mobile window syndromes, higher resolution imaging protocols, and several sensitive and specific diagnostic tests. Furthermore, we have a treatment (surgical occlusion of the superior semicircular canal) that has demonstrated efficacy. This review will highlight some of the fundamental insights gained in SCDS, propose diagnostic criteria, and discuss future research directions.
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Affiliation(s)
- Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lloyd B. Minor
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Jan TA, Cheng YS, Landegger LD, Lin BM, Srikanth P, Niesten MEF, Lee DJ. Relationship between Surgically Treated Superior Canal Dehiscence Syndrome and Body Mass Index. Otolaryngol Head Neck Surg 2017; 156:722-727. [DOI: 10.1177/0194599816686563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Examine the association between body mass index (BMI) and superior canal dehiscence (SCD) among patients who have undergone surgical repair for superior canal dehiscence. Study Design Retrospective comparison study. Setting Neurotology tertiary care center. Subjects and Methods Retrospective review of consecutive adult patients evaluated at our institution for SCD syndrome between November 2006 and August 2015. A control group who underwent imaging within the same period for reasons other than SCD was also included. Patient demographics, weight, and height were examined. We performed multiple subgroup analyses to investigate the relationship of BMI, surgery vs no surgery, and correlation between patient BMI and SCD size. Results Of the 268 patients with SCD, 99 underwent surgery; 96 of these patients had complete medical records and were eligible for inclusion. Eighty-eight patients were noted to have arcuate eminence defects, and the mean BMI of this surgical cohort was 28.09 ± 5.26 kg/m2. Nonsurgically treated patients with SCD with available data (n = 94) had a mean BMI of 27.97 ± 6.95 kg/m2. A control group of 204 patients who underwent computed tomography for non-SCD-related causes was analyzed, of whom 155 had available data with a mean BMI of 27.91 ± 6.38 kg/m2. Conclusion We demonstrate that adult patients who undergo surgery for SCD are not obese (mean BMI <30), and size of dehiscence poorly correlates with BMI. Our observations call into question the proposed theory that patient weight is a risk factor for the development of symptomatic SCD involving the arcuate eminence.
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Affiliation(s)
- Taha A. Jan
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yew Song Cheng
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Lukas D. Landegger
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M. Lin
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Priya Srikanth
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Marlien E. F. Niesten
- Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center, Utrecht, the Netherlands
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Bi WL, Brewster R, Poe D, Vernick D, Lee DJ, Eduardo Corrales C, Dunn IF. Superior semicircular canal dehiscence syndrome. J Neurosurg 2017; 127:1268-1276. [PMID: 28084916 DOI: 10.3171/2016.9.jns16503] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) syndrome is an increasingly recognized cause of vestibular and/or auditory symptoms in both adults and children. These symptoms are believed to result from the presence of a pathological mobile "third window" into the labyrinth due to deficiency in the osseous shell, leading to inadvertent hydroacoustic transmissions through the cochlea and labyrinth. The most common bony defect of the superior canal is found over the arcuate eminence, with rare cases involving the posteromedial limb of the superior canal associated with the superior petrosal sinus. Operative intervention is indicated for intractable or debilitating symptoms that persist despite conservative management and vestibular sedation. Surgical repair can be accomplished by reconstruction or plugging of the bony defect or reinforcement of the round window through a variety of operative approaches. The authors review the etiology, pathophysiology, presentation, diagnosis, surgical options, and outcomes in the treatment of this entity, with a focus on potential pitfalls that may be encountered during clinical management.
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Affiliation(s)
- Wenya Linda Bi
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Ryan Brewster
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Dennis Poe
- 2Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital.,3Department of Otolaryngology, Harvard Medical School
| | - David Vernick
- 3Department of Otolaryngology, Harvard Medical School
| | - Daniel J Lee
- 3Department of Otolaryngology, Harvard Medical School.,4Department of Otolaryngology, Massachusetts Eye and Ear Infirmary; and.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - C Eduardo Corrales
- 3Department of Otolaryngology, Harvard Medical School.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian F Dunn
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
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Bilateral Petrous Apex Cephaloceles and Skull Base Attenuation in Setting of Idiopathic Intracranial Hypertension. Otol Neurotol 2016; 37:e256-7. [DOI: 10.1097/mao.0000000000001092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rizk HG, Hatch JL, Stevens SM, Lambert PR, Meyer TA. Lateral Skull Base Attenuation in Superior Semicircular Canal Dehiscence and Spontaneous Cerebrospinal Fluid Otorrhea. Otolaryngol Head Neck Surg 2016; 155:641-8. [DOI: 10.1177/0194599816651261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/03/2016] [Indexed: 12/29/2022]
Abstract
Objectives (1) To quantitatively assess the lateral skull base thickness in patients with superior semicircular canal dehiscense (SSCD) using a standardized and validated radiographic measure and to compare it with that of a population with spontaneous cerebrospinal fluid otorrhea (CSFO). (2) To analyze demographic and clinical factors associated with skull base thickness in the SSCD group. Study Design Case series with chart review. Setting Tertiary neurotologic referral center. Subjects and Methods Based on computed tomography imaging of the tegmen, mean skull base thickness was calculated for 16 patients with radiographic and clinical SSCD. Similar measures were performed in 4 comparison groups consisting of adults with spontaneous CSFO (n = 33), as well as 3 control groups recruited from our adult cochlear implant database: 30 obese controls (body mass index [BMI] >30 kg/m2), 11 overweight controls (BMI, 25-30 kg/m2), and 20 normal weight controls (BMI <25 kg/m2). Results The SSCD group had a significantly lower mean BMI (28.6 kg/m2) than the spontaneous CSFO group (37.7 kg/m2; P = .0007). The mean skull base thickness of SSCD patients was 17% thinner than that of the CSFO group, 31% thinner vs obese controls, 49% thinner vs overweight controls, and 45% thinner vs normal weight controls. These differences were all statistically significant ( P < .05). Conclusion Patients with SSCD have a marked thinning of the lateral skull base, more so than patients with spontaneous CSF otorrhea and control groups with different BMIs. Skull base attenuation in SSCD patients did not correlate with BMI.
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Affiliation(s)
- Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan L. Hatch
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shawn M. Stevens
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R. Lambert
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
PURPOSE OF REVIEW This article aims to review relevant implications of obesity and associated comorbid conditions for the otology and neurotology surgical subspecialties. RECENT FINDINGS Both the incidence and prevalence of obesity are rising worldwide. This condition, along with its many associated comorbidities, can adversely affect the perioperative management of patients undergoing otologic and neurotologic procedures. Preoperative assessment of the cardiopulmonary system and airway are imperative as compromise of either may lead to death. Physiologic changes found in patients with obesity have been shown to predispose to hemodynamic instability, intolerance of hypoxia, bleeding, thrombo-embolism, poor wound healing, and decreased drug clearance. An 'obesity paradox' may exist in which patients who are overweight or obese may have less perioperative morbidity and mortality. Patients who are underweight or morbidly obese seem to have worse surgical outcomes. Obesity has been associated with intracranial hypertension, risk of cerebrospinal fluid (CSF) leak recurrence, and skull base erosion leading to multiple pathologic conditions. These include spontaneous CSF otorrhea, semicircular canal dehiscence syndrome, and sigmoid sinus diverticulum. SUMMARY The obese habitus and physiology significantly affects patients undergoing otologic and neurologic surgeries. A thorough understanding of this condition is paramount to successful outcomes.
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Schutt CA, Kveton JF. Posterior semicircular canal dehiscence secondary to jugular enlargement. Am J Otolaryngol 2016; 37:173-4. [PMID: 27178502 DOI: 10.1016/j.amjoto.2015.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022]
Abstract
Semicircular canal dehiscence is an important entity often presenting with symptoms of noise or pressure induced vertigo, autophony, aural fullness and conductive hearing loss. Due to its varied presentation and mimic of other otologic conditions its consideration is of increased importance. Within we report a case of right sided posterior semicircular canal dehiscence secondary to an enlarged and high jugular bulb. The results of this observation indicate a need for patients with auditory symptoms and high riding jugular bulbs to be evaluated for possible posterior semicircular canal dehiscence.
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