Postoperative Pneumolabyrinth Following the Middle Cranial Fossa Approach for Superior Semicircular Canal Dehiscence Repair, 2014‐2020

Abstract

Objective The present study investigates risk factors and clinical outcomes of postoperative pneumolabyrinth following the middle cranial fossa approach for superior semicircular canal dehiscence repair, a complication that has not been documented previously. Study Design Retrospective cohort study. Setting Tertiary/quaternary care referral center. Methods We conducted a retrospective review of 332 middle cranial fossa procedures from 2014 to 2020 at a tertiary/quaternary care institution. Upon identifying pneumolabyrinth cases from postoperative computed tomography temporal bone scans, we conducted multivariable logistic regression analysis to explore demographic and clinical factors that were independently linked to this complication. We also compared the rates of postoperative symptoms among patients with different grades of pneumolabyrinth. Results We identified 41 (12.3%) pneumolabyrinth cases. Patients with older age, higher preoperative pure tone average, and frank dehiscence were at higher risk for pneumolabyrinth. Furthermore, patients with pneumolabyrinth reported significantly higher rates of postoperative dizziness and exhibited significantly greater pure tone average and air-bone gap postoperatively as compared with patients without pneumolabyrinth. Finally, higher-grade pneumolabyrinth was associated with increased rates of postoperative hearing loss, and grade III pneumolabyrinth was associated with higher rates of postoperative tinnitus vs grade I and II cases. Conclusion Pneumolabyrinth following the middle cranial fossa approach was associated with poor clinical outcomes, including dizziness and auditory impairment. Old age, high preoperative pure tone average, and frank dehiscence were risk factors for this complication. The highlighted parameters may be important to note when considering this approach as a treatment option and while monitoring postoperative recovery.

Low‐Lying Tegmen and Surgical Outcomes Following the Middle Cranial Fossa Repair of Superior Canal Dehiscence

“…The site was then sealed with fibrin glue, helostat, or a titanium burr hole cover. Additional information regarding repair techniques were detailed previously 21‐24 …”

“…While the MCF repair of SCD has been safe and effective for nearly 20 years, outcomes can vary between patients 4‐9 . Hence, factors that can predict treatment response are informative for candidate selection and counseling.…”

Audiometric Outcomes After the Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence

“…Perioperative audiometry data may provide insights regarding alterations to the inner ear mechanics that are induced by the MCF procedure. Auditory function is also important to monitor perioperatively as dehiscence plugging can potentially perturb the inner ear acoustic environment and impair hearing (3,(9)(10)(11).…”

Radiographic Estimation of Superior Canal Dehiscence Area and Surgical Outcomes Following the Middle Fossa Approach

“…2 Symptomatic outcomes were evaluated with two previously developed measures, symptom resolution score (SRS) and rate of overall symptom improvement (OSI). 3 Multivariable logistic regression assessing OSI and bootstrapped linear regression assessing SRS were performed with ADA as the primary predictor. All models controlled for patient age, sex, dehiscence location, prior surgery of the affected ear, and follow-up duration.…”