Diagnostic Yield of Patients Undergoing Evaluation of Possible Superior Canal Dehiscence

Abstract

ObjectiveTo characterize the diagnostic yield of patients undergoing evaluation for superior canal dehiscence syndrome (SCDS), and identify alternative conditions diagnosed in patients suspected of, but not ultimately diagnosed with, SCDS.MethodsDiagnostically undifferentiated adult patients suspected of having SCDS were identified between 2016 and 2021 at a tertiary academic medical system. Patients were categorized by diagnostic testing, radiographic superior semicircular canal (SSC) abnormality, symptoms, evaluating clinician specialty, operative intervention, and diagnosis. Differences among groups were assessed for statistical significance.ResultsOf 1242 candidate patients, 477 met inclusion criteria—evaluation by a clinician with SCDS on their differential diagnosis prior to diagnostic imaging. The mean (SD) age was 53.0 (15.0) years and 70.6% were female. A total of 364 patients underwent subsequent diagnostic imaging, and among these, 164 (45.1%) had a radiographic SSC abnormality with 99 (27.2%) receiving a diagnosis of SCDS (two cases of “near dehiscence syndrome”). One third (33.3%) of patients with SCDS underwent operative repair. Most clinicians with the initial suspicion for SCDS were otolaryngologists (90.6%), who had greater diagnostic yield than clinicians from other specialties (22.2% vs. 6.7%, p = 0.012). Patients not diagnosed with SCDS alternatively received 21 unique diagnoses and 52.1% (138/265) were not definitively diagnosed with any condition.ConclusionsThis study characterizes the diagnostic incidence, or yield, of newly identified radiographic SSC abnormalities (45.1%) and SCDS (27.2%) among people suspected of having SCDS. Considerable overlap in presentation between SCDS and other conditions exists, and there is need for improvement in efficiently diagnosing patients with SCDS and audio‐vestibular complaints in general.Level of EvidenceIII Laryngoscope, 2024

Association Between Superior Canal Dehiscence Syndrome and Anxiety and Depressive Disorders

“…[1][2][3] The symptom profile of SCDS overlaps with many other otologic and neurologic diseases, which when compounded with its rarity may lead to diagnostic delays. [4][5][6][7] Studies investigating the psychological burden of living with rare disease have found some may be associated with elevated rates of anxiety and depression. 8,9 Research evaluating psychiatric illness among patients with SCDS is limited to qualitative reports of associated depression and anxiety and one study demonstrating decreased health-related quality of life.…”