Effectiveness of Transmastoid Plugging for Semicircular Canal Dehiscence Syndrome

Objectives (1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome. Study Design Case series with chart review. Setting Single tertiary care institution. Subjects and Methods We retrospectively reviewed patients with SSCD who underwent repair with canal plugging via a transmastoid approach between January 2012 and January 2017. Symptom severity was assessed prospectively (autophony, sound/pressure-induced vertigo, disequilibrium, aural fullness, and pulsatile tinnitus) and after surgery. Pure-tone and speech audiometry were measured before and after surgery. Two-sided Wilcoxon rank-sum tests were used to evaluate changes in subjective symptoms and audiometric outcomes. Results Seventeen patients (19 ears) met inclusion criteria. The superior canal was successfully plugged via the transmastoid approach in all cases. Patients reported a statistically significant improvement in autophony, vertigo, aural fullness, and pulsatile tinnitus ( P < .01), without significant improvement in disequilibrium rating ( P = .06). There were no changes noted in pure-tone average or word recognition score; however, there was a statistically significant improvement in air-bone gap at 250 Hz of 10.9 dB ( P = .04) with 12.9-dB improvement in air conduction thresholds ( P = .02) and no difference (0.9 dB, P = .9) in bone conduction thresholds. Conclusion In our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach.

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Simultaneous, unilateral plugging of superior and posterior semicircular canal dehiscences to treat debilitating hyperacusis

The Journal of Laryngology & Otology ◽

10.1017/s0022215113003605 ◽

2014 ◽

Vol 128 (2) ◽

pp. 174-178 ◽

Cited By ~ 10

Author(s):

P T Dang ◽

T A Kennedy ◽

S P Gubbels

Keyword(s):

Semicircular Canal ◽

Bone Conduction ◽

Vascular Anatomy ◽

Jugular Bulb ◽

Sigmoid Sinus ◽

Posterior Semicircular Canal ◽

Vestibular Evoked Myogenic Potential ◽

Superior Semicircular Canal Dehiscence ◽

Transmastoid Approach ◽

Canal Dehiscence

AbstractObjective:To describe a case of bilateral superior and posterior semicircular canal dehiscences, and the use of a unilateral transmastoid approach to address both right-sided defects simultaneously.Case report:In a patient with right-sided hyperacusis, bilateral dehiscence of both the superior and the posterior semicircular canals was identified, located adjacent to the common crus, together with a right-sided, anterosuperiorly positioned sigmoid sinus and a high-riding jugular bulb. Results for audiography and cervical vestibular evoked myogenic potential testing were consistent with right-sided semicircular canal dehiscence. At surgery, a right-sided transmastoid approach provided access to plug both defects simultaneously, following posterior mobilisation of the sigmoid sinus. The patient's hyperacusis was completely resolved, with a 10–30 dB improvement in his right ear air conduction hearing, without decrement in bone conduction.Conclusion:In properly selected patients, a transmastoid approach can be used to effectively manage superior semicircular canal dehiscence and posterior semicircular canal dehiscence simultaneously. Pre-operative computed tomography is recommended to evaluate the dehiscence sites and to identify complicating vascular anatomy.

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Dural Contact to the Malleus Head in Patients with Superior Semicircular Canal Dehiscence (SSCD): Case Series and Review of SSCD and Tegmen Defects

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211007257 ◽

2021 ◽

pp. 000348942110072

Author(s):

Carissa Wentland ◽

Joseph Cousins ◽

Jason May ◽

Arnaldo Rivera

Keyword(s):

Semicircular Canal ◽

Tertiary Care ◽

Case Series ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

Tegmen Tympani ◽

Limited Series ◽

Tertiary Care Institution ◽

The Mean ◽

Canal Dehiscence

Objective: Report a series of cases in which patients have concomitant superior semicircular canal dehiscence (SSCD) and a dehiscent tegmen tympani with Dural contact to the malleus head (DCMH). Methods: An analysis of radiologic and audiologic data in 4 patients who presented with SSCD and DCMH at a tertiary care institution. A pertinent literature review was performed. Results: Four patients (5 ears) had SSCD and DCMH. In 3 patients with unilateral DCMH, the mean maximum air-bone gap was 15 dB in the ear with DCMH compared to 50 dB in the ear without DCMH. Of the 5 ears with DCMH, the mean air conduction threshold at 250 Hz was 17 dB compared to 42 dB in the 3 ears without DCMH. Conclusions: We report the findings of DCMH in a series of 4 patients with bilateral SSCD. This limited series suggests that ears with SSCD and DCMH have less of an air-bone gap than would be expected, as 1 would expect an additive effect of DCMH and SSCD on the air-bone gap.

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Sealing of superior semicircular canal dehiscence is associated with improved balance outcomes postoperatively versus plugging of the canal in middle fossa craniotomy repairs: a case series

Journal of Neurosurgery ◽

10.3171/2019.4.jns19264 ◽

2020 ◽

Vol 133 (2) ◽

pp. 462-466

Author(s):

Vivian Wung ◽

Prasanth Romiyo ◽

Edwin Ng ◽

Courtney Duong ◽

Thien Nguyen ◽

...

Keyword(s):

Semicircular Canal ◽

Chart Review ◽

Case Series ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

Postoperative Mri ◽

Mri Scans ◽

Postoperative Symptoms ◽

Fluid Signal ◽

Canal Dehiscence

OBJECTIVEThe authors compared postoperative symptoms between patients with sealed and those with plugged semicircular canal dehiscence repairs.METHODSIn total, 136 ears from 118 patients who underwent surgical repair for semicircular canal dehiscence were identified via chart review. Data from postoperative MRI scans showing preservation or loss of semicircular canal fluid signal and postoperative reports of autophony, amplification, aural fullness, tinnitus, hyperacusis, hearing loss, vertigo, dizziness, disequilibrium, oscillopsia, and headache were amalgamated and analyzed.RESULTSPatients with preservation of fluid signal were far less likely to have dizziness postoperatively (p = 0.007, OR 0.158, 95% CI 0.041–0.611). In addition, these patients were more likely to have tinnitus postoperatively (p = 0.028, OR 3.515, 95% CI 1.145–10.787).CONCLUSIONSThe authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging.

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Superior Semicircular Canal Dehiscence Syndrome: Review of Clinical Manifestations in Adults and Children

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v24i2.675 ◽

2009 ◽

Vol 24 (2) ◽

pp. 6-13

Author(s):

Scheherazade C. Ibrahim ◽

Charlotte M. Chiong ◽

Nathaniel W. Yang

Keyword(s):

Semicircular Canal ◽

Clinical Manifestations ◽

Case Series ◽

Vestibular Evoked Myogenic Potential ◽

Superior Semicircular Canal Dehiscence ◽

Computed Tomographic ◽

Myogenic Potential ◽

Superior Semicircular Canal ◽

Computed Tomographic Scan ◽

Canal Dehiscence

Objective: This report aims to determine the clinical manifestations and management of patients with superior semicircular canal dehiscence syndrome (SSCDS). Methods: Study Design: Case series. Setting: Tertiary hospitals and private clinics Participants: Out of 30 patients with vestibular vertigo or otologic symptom, 14 patients were diagnosed with SSCDS based on high resolution computed tomographic scan (HRCT). The demographic features, incidence of specific signs and symptoms and management of these patients were described, including the audiograms, vestibular evoked myogenic potential (VEMP) responses and ancillary tests. Results: Vertigo was the most common vestibular symptom of SSCDS. Tullio phenomenon was elicited in 50% of patients with confirmed dehiscence on HRCT scan. Low frequency (250 Hz and 500 Hz) air-bone gap was noted in 21.4% of patients. Lowered VEMP responses were also noted in 66.7% of patients with confirmed SSCDS. Severity of symptoms may determine its management. Conclusion: The diagnosis of SSCDS does not conform to a specific clinical presentation or audiologic result thus good clinical correlation is needed in order to raise suspicion of the disease and prompt the clinician to order confirmatory imaging by computed tomographic scan or magnetic resonance imaging. The presence of this syndrome in a proportion of children that is greater than previously reported needs further study as these children may be genetically predisposed to have thinned out superior semicircular canals that eventually become dehisced albeit at an earlier age. Key words: Superior semicircular canal dehiscence, pure tone audiometry, vestibular evoked myogenic potential

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Pulsatile Tinnitus in Superior Semicircular Canal Dehiscence Cured by Endovascular Coil Occlusion of the Superior Petrosal Sinus

Otology & Neurotology ◽

10.1097/mao.0000000000003012 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Grace E. Aw ◽

Geoffrey D. Parker ◽

Gabor Michael Halmagyi ◽

Alexander J. Saxby

Keyword(s):

Semicircular Canal ◽

Pulsatile Tinnitus ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

Coil Occlusion ◽

Superior Petrosal Sinus ◽

Canal Dehiscence

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Surgical Outcomes Following Transmastoid Approach for Repair of Superior Semicircular Canal Dehiscence

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1579888 ◽

2016 ◽

Vol 77 (S 01) ◽

Cited By ~ 1

Author(s):

Thomas Babcock ◽

Simon Angeli ◽

Fred Telischi ◽

Michael Hoffer ◽

Adrien Eshraghi ◽

...

Keyword(s):

Semicircular Canal ◽

Surgical Outcomes ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

Transmastoid Approach ◽

Canal Dehiscence

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Case Report: Local Anesthesia Round Window Plugging and Simultaneous Vibrant Soundbridge Implant for Superior Semicircular Canal Dehiscence

Frontiers in Neurology ◽

10.3389/fneur.2020.581783 ◽

2020 ◽

Vol 11 ◽

Author(s):

Giulia Mignacco ◽

Lorenzo Salerni ◽

Ilaria Bindi ◽

Giovanni Monciatti ◽

Alfonso Cerase ◽

...

Keyword(s):

Semicircular Canal ◽

Round Window ◽

Bone Conduction ◽

Hearing Threshold ◽

Vestibular Evoked Myogenic Potentials ◽

Vibrant Soundbridge ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

The Right ◽

Canal Dehiscence

The aim of the present study is to report the outcomes of round window reinforcement surgery performed with the application of a Vibrant Soundbridge middle ear implant (VSB; MED-EL) in a patient with superior semicircular canal dehiscence (SSCD) who presented with recurrent vertigo, Tullio phenomenon, Hennebert's sign, bone conduction hypersensitivity, and bilateral moderate to severe mixed hearing loss. Vestibular evoked myogenic potentials (VEMPs) and high-resolution computed tomography (HRCT) confirmed bilateral superior semicircular canal dehiscence while this was not seen in magnetic resonance imaging. The surgical procedure was performed in the right ear as it had worse vestibular and auditory symptoms, a poorer hearing threshold, and greatly altered HRCT and VEMPs findings. With local-assisted anesthesia, round window reinforcement surgery (plugging) with perichondrium was performed with simultaneous positioning of a VSB on the round window niche. At the one and 3 months follow-up after surgery, VSB-aided hearing threshold in the right ear improved to mild, and loud sounds did not elicit either dizziness or pain in the patient.

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