Correlation of Superior Canal Dehiscence Surface Area With Vestibular Evoked Myogenic Potentials, Audiometric Thresholds, and Dizziness Handicap

Abstract

Objective To correlate objective measures of vestibular and audiometric function as well as subjective measures of dizziness handicap with the surface area of the superior canal dehiscence (SCD) Study Design Retrospective chart review and radiological analysis Setting Single tertiary academic referral center Patients Preoperative CT imaging, patient survey, audiometric thresholds, and VEMP testing in patients with confirmed SCD Intervention(s) Image analysis techniques were developed to measure the surface area of each SCD in CT imaging. Main outcome measure(s) Preoperative ocular and cervical VEMPs, air and bone conduction thresholds, ABG, dizziness handicap inventory scores, and surface area of the SCD Results Fifty-three patients (mean age 52.7 years) with 84 SCD were analyzed. The median surface area of dehiscence was 1.44 mm2 (0.068-8.23 mm2). Ocular VEMP amplitudes (r = 0.61, p < 0.0001), cervical VEMP amplitudes (r = 0.62, p < 0.0001), air conduction thresholds at 250 Hz (r = 0.25, p = 0.043), and ABG at 500 Hz (r = 0.27, p =0.01) positively correlated with increasing size of dehiscence. An inverse relationship between cervical VEMP thresholds (r = −0.56, p < 0.0001) and surface area of the dehiscence was observed. No association between dizziness handicap and surface area was identified. Conclusions Among patients with confirmed SCD, ocular and cervical VEMP amplitudes, cervical VEMP thresholds, and air conduction thresholds at 250 Hz are significantly correlated with the surface area of the dehiscence.

Investigation of Mechanisms in Bone Conduction Hyperacusis With Third Window Pathologies Based on Model Predictions

“…The ABG in Figure 5C show a monotonic increase with increasing size of the dehiscence at frequencies below 1 kHz. This is in line with reports from clinical and experimental studies ( 14 , 46 , 47 ). Hunter et al ( 46 ) computed the correlation between dehiscence size and ABG at 500 Hz and reported it to be r = 0.27.…”

“…The simulations were done for a dehiscence area of up to 6 mm 2 . The limitation to 6 mm 2 was based on the study by Hunter et al ( 46 ) that reported most dehiscence areas to be 6 mm 2 or smaller, with mean areas in different studies ranging from 1.44 to 3.19 mm 2 . The ABG in Figure 5C show a monotonic increase with increasing size of the dehiscence at frequencies below 1 kHz.…”

A Comparison of Two Recording Montages for Ocular Vestibular Evoked Myogenic Potentials in Patients with Superior Canal Dehiscence Syndrome

“…Future research is needed to examine the impact of the size of the dehiscence on the oVEMP response with the belly-tendon electrode montage. Hunter et al (2016) found a significant interaction of oVEMP amplitude and the size of the dehiscence when the response was measured with the infraorbital electrode montage (i.e., the oVEMP amplitude increased as the size of the dehiscence increased). In this regard, in cases of smaller dehiscence, the bellytendon montage may offer a higher sensitivity.…”

“…Although the gold standard confirmatory test is a high-resolution computed tomography (CT) scan with fine cuts, audiological tests can be used to corroborate the presence of SCDS and to evaluate if the SCDS is active and symptomatic. To date, pure-tone audiometry and vestibular evoked myogenic potential testing (VEMPs) have been shown to be clinically useful in this population (Brantberg et al, 1999;Belden et al, 2003;Hunter et al, 2016). Both the sensitivity and specificity of the ocular VEMP (oVEMP) and cervical VEMP (cVEMP) have been investigated for identifying SCDS (Zuniga et al, 2013).…”

Moderne Schwindeldiagnostik

“…Hinweise für ein Dehiszenzsyndrom ergeben sich, wenn verminderte VEMP-Schwellen bei der Luftleitungsstimulation mit 500 Hz sowie erhöhte VEMP-Amplituden nachweisbar sind [217]. Hunter et al wiesen nach, dass cVEMP und oVEMP-Amplituden und cVEMP-Schwellen mit dem Ausmaß einer Dehiszenz korrelieren [218]. Nach Brantberg und Verrecchia ist bei einem klinischen Verdacht auf ein Dehiszenzsyndrom die Stimulation mit 90 dB nHL ausreichend [219].…”