<scp>First‐Side</scp> and <scp>Second‐Side</scp> Repair of Bilateral Superior Canal Dehiscence

Yang, Hong‐Ho; Yang, Isaac; Gopen, Quinton S.

doi:10.1002/lary.31118

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…This may introduce bias, as differences in presentation and outcome have been noted between unilateral and bilateral SSCD [ 12 , 15 , 28 , 34 ]. However, our findings of greater symptom resolution with unilateral relative to bilateral repair are consistent with prior studies [ 21 , 35 ]. The present study presents the largest known single institution cohort of SSCD repairs.…”

Section: Discussionsupporting

confidence: 93%

Superior semicircular canal dehiscence postoperative outcomes: a case series of 350 repairs

Mekonnen,

Lum,

Duong

et al. 2024

Acta Neurochir

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Background Superior Semicircular Canal Dehiscence (SSCD) is a dehiscence of the otic capsule which normally lies over the superior semicircular canal. This database constitutes the largest series of SSCD patients to date. Objective To determine what preoperative factors, if any, contribute to postoperative outcomes and evaluate symptom resolution in a large SSCD patient cohort. Methods A single-institution, retrospective chart review collected patient demographics, intraoperative findings, and pre-and postoperative symptoms. Fisher's exact t-test was performed for unpaired categorical variables, with a significance level of p < 0.05. Results 350 SSCD repairs were performed. The median age was 52 years (range: 17—86 years, ± 6.4 years), and the median follow-up duration was 4.6 months (range: 0.03—59.5 months, ± 6.8 months). Preoperative hearing loss was significantly associated with female sex (p = 0.0028). The most reported preoperative symptoms were tinnitus (77.4%), dizziness (74.0%), autophony (66.3%), amplification (63.7%), and disequilibrium (62.6%). Between patients who received unilateral versus bilateral SSCD repair, the greatest postoperative symptomatic resolution was seen in autophony (74.9%, p < 0.001), amplification (77.3%, p = 0.00027), hyperacusis (77.4%, p = 0.023), hearing (62.9%, p = 0.0063), and dizziness (54.6%, p < 0.001) for patients with unilateral SSCD repair. Conclusion Surgical repair via the middle cranial fossa approach can significantly resolve auditory, vestibular, and neurological symptoms of patients with SSCD. Although this is one of the largest single-institution SSCD studies to date, future multi-institutional, prospective studies would be beneficial to validate these results.

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Section: Discussionsupporting

confidence: 93%

Superior semicircular canal dehiscence postoperative outcomes: a case series of 350 repairs

Mekonnen,

Lum,

Duong

et al. 2024

Acta Neurochir

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“…Vestibular symptoms evaluated include disequilibrium, vertigo, dizziness, and oscillopsia. Two previously developed measures of symptom response were computed for this study: overall symptom improvement (OSI) and symptom resolution score (SRS) 16 . OSI evaluates whether a patient experienced the net resolution of at least 1 symptom following surgery, and SRS evaluates the proportion (%) of preoperative symptoms that resolved following surgery (out of 100).…”

Section: Methodsmentioning

confidence: 99%

“…Two previously developed measures of symptom response were computed for this study: overall symptom improvement (OSI) and symptom resolution score (SRS). 16 OSI evaluates whether a patient experienced the net resolution of at least 1 symptom following surgery, and SRS evaluates the proportion (%) of preoperative symptoms that resolved following surgery (out of 100). As described previously, we calculated 3 versions of OSI and SRS: overall, auditory, and vestibular.…”

Section: Variable Characterizationmentioning

confidence: 99%

Narrowing of Low‐Frequency Air‐Bone Gap and Its Association with Symptom Resolution Following Superior Canal Dehiscence Repair

Yang,

Gopen

2023

Otolaryngol.--head neck surg.

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ObjectiveLow‐frequency air‐bone gap (LABG) on pure tone audiometry is an expected clinical finding of superior canal dehiscence (SCD) syndrome. We investigate how narrowing of LABG following SCD repairs translates to symptom resolution.Study DesignCohort study.SettingTertiary Care Center.MethodsWe analyzed consecutive SCD repairs at an institution between 2012 and 2022. Pure tone audiometry and symptom questionnaires were administered pre‐ and post‐operatively. The independent variable assessed whether the LABG narrowed (≥5 dB) following surgery. Outcome measures were rates of Overall Symptom Improvement (OSI, net resolution of ≥1 symptom) and Symptom Resolution Score (SRS, % symptoms resolved). We conducted multivariable regression analyses with LABG narrowing as the primary predictor. All models controlled for demographics, bilateral disease, prior ear surgery, and follow‐up.ResultsAmong total of 217 repairs analyzed, 161 (74%) reached OSI, and mean SRS was 39 (out of 100). LABG narrowing at 250 Hz (65%), 500 Hz (52%), and 1000 Hz (47%) was associated with a 41‐point (β 95% confidence interval [CI] 5‐77) increase in auditory, 15‐point (β 95% CI 1‐30) increase in auditory, and 23‐point (β 95% CI 2‐45) increase in vestibular SRS, respectively. However, LABG narrowing was not significantly associated with the rates of auditory and vestibular OSI at all frequencies assessed.ConclusionLack of LABG narrowing following repair was associated with the persistence of a greater proportion of preoperative symptoms but similar likelihood of OSI. This relationship was more prominent for auditory symptoms at 250 to 500 Hz and for vestibular symptoms at 1000 Hz. Additional research is warranted to elucidate the mechanism through which symptoms resolve despite LABG persistence.

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Symptomatology in Unilateral Versus Bilateral Superior Canal Dehiscence Patients Undergoing Unilateral Surgery

Suresh,

Garcia,

Nwosu

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo compare symptomatology in patients with unilateral versus bilateral superior semicircular canal dehiscence who underwent unilateral surgical repair.Study DesignRetrospective cohort study.SettingSingle surgeon series at tertiary academic medical center from 2002 to 2021.MethodsPatients were administered a standardized questionnaire regarding the presence or absence of 16 symptoms (11 auditory and 8 vestibular) pre‐ and postoperatively. Symptom rates were compared between patients with unilateral and bilateral dehiscence, and paired statistical testing was used to analyze symptom improvement with surgery.ResultsOur final cohort included 125 patients, 93 (74%) with unilateral superior canal dehiscence syndrome (SCDS) and 32 (26%) with bilateral SCDS. Bilateral patients had an increased burden of auditory and vestibular symptoms compared to unilateral patients before surgery (7.6 vs 6.2, P = .03) and after surgery (3.1 vs 1.9, P = .02). Both groups experienced a significant reduction of symptoms following repair (P < .01 for both).ConclusionOur study has 2 key findings: First, patients with bilateral dehiscence seem to be more symptomatic, reporting more auditory and vestibular symptoms both before and after surgery. Second, bilateral patients still seem to benefit from unilateral repair, demonstrating a significant reduction in the number of symptoms with surgery. Our findings may help inform the management of the sizable proportion of SCDS patients with bilateral defects.

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First‐Side and Second‐Side Repair of Bilateral Superior Canal Dehiscence

Cited by 5 publications

References 25 publications

Superior semicircular canal dehiscence postoperative outcomes: a case series of 350 repairs

Superior semicircular canal dehiscence postoperative outcomes: a case series of 350 repairs

Narrowing of Low‐Frequency Air‐Bone Gap and Its Association with Symptom Resolution Following Superior Canal Dehiscence Repair

Symptomatology in Unilateral Versus Bilateral Superior Canal Dehiscence Patients Undergoing Unilateral Surgery

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