Superior Canal Dehiscence Surgery Outcomes Following Failed Round Window Surgery

Chemtob, Raphaelle A.; Noij, Kimberley S.; Qureshi, Ahad; Klokker, Mads; Nakajima, Hideko Heidi; Lee, Daniel J

doi:10.1097/mao.0000000000002185

Cited by 16 publications

(11 citation statements)

References 14 publications

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“…Multiple reinforcement materials were used in our study, including fascia, cartilage, and periosteum, though in only 4% of cases were materials other than fascia used. There is concern that over-stiffening the round window could lead to increased energy diverted toward the defect in SSCD; however, changing reinforcement materials with different stiffness has not been shown to have a large effect on patients with SSCD (22,23). The current study had one patient that did have a significant 20 dB increase in PTA postoperatively and only a 5 dB increase in ABG, suggesting a primarily sensorineural component to the hearing loss.…”

Section: Discussionmentioning

confidence: 65%

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Conway

Pinther

et al. 2021

Otology &Amp; Neurotology

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Introduction:Oval window (OW) and round window (RW) reinforcement surgery has been used for symptomatic treatment of multiple clinical entities, most commonly perilymphatic fistula and superior semicircular canal dehiscence. Owing to the theoretical acoustically negative effect of stiffening the windows, there has been concern of an unfavorable effect on audiologic outcomes due to the procedure. The purpose of this study is to specifically evaluate audiologic outcomes after OW and RW reinforcement.Methods:A retrospective review of patients undergoing transcanal OW or RW reinforcement was completed. Patients were evaluated both as a total group and as two groups separated into “third window” and “two-window” groups based on their specific diagnosis. Primary outcomes included changes in individual pure-tone thresholds, pure-tone average (PTA), air-bone gap, speech reception threshold (SRT), and word recognition scores (WRS) between the preoperative and postoperative groups.Results:Seventy-one patients were included in the study. The combined cohort demonstrated a significant postoperative 2.75 dB increase in the air conduction hearing level at 4000 Hz (p < 0.05). This was almost entirely accounted for by a 2.18 dB increase in the air-bone gap at this frequency (p < 0.05). There were no significant changes in PTA, SRT, or WRS between in the combined group or in the subgroup analysis.Conclusion:OW and RW tissue reinforcement resulted in a statistically significant but likely clinically insignificant decrease in hearing at the 4000 Hz frequency. There was no worsening of PTA, WRS, or SRT.

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Section: Discussionmentioning

confidence: 65%

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Conway

Pinther

et al. 2021

Otology &Amp; Neurotology

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“…We aimed to meet the demands of long-term outcomes after standardized RWR (14,16,18) with a focus on PROMs. On average 3 years postoperatively, RWR with thin cartilage and perichondrium resulted in further surgery in 9/28 ears (32%).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome

Bunne

Andersson

Myhrum

2022

Otology &Amp; Neurotology

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ObjectiveTo report long-term patient reported outcome measures (PROMs) after standardized round window rein-forcement (RWR) with thin cartilage and perichondrium for superior semicircular canal dehiscence syndrome (SSCDS).MethodsCross-sectional survey in 2020 and retrospective longitudinal study of outcomes at 3 months, 1 year, and last follow-up after 28 consecutive RWRs. Endpoints were the last follow-up for PROMs and 1 year postoperatively for audiometry and cVEMP.ResultsAt the last follow-up (mean 2.4 years postoperatively), improvement was reported for 19/28 ears (68%) in symptoms overall; for 17/27 ears (63%) in auditory symptoms, and for 12/24 (50%) in vestibular symptoms. Nine ears (32%) required further surgery. No major complications occurred. On the group level, postoperative improvement at 3 months declined significantly for auditory and vestibular symptoms over time, and stayed stable beyond 1 year. Improved ears had on average 2.9 years follow-up. Improvement correlated significantly with SSCD length, and was associated with contralateral dehiscence. Thirteen ears (46%) had another potential cause of vestibular symptoms. This group showed significantly less improvement. Audiometric test results did not predict PROMs.ConclusionsSince long-term outcomes do not compare with those reported for plugging and repair, RWR is not suggested as a first line intervention for SSCDS. Considering the stable rates of improvement on average 2.9 years postoperatively and the absence of major complications, RWR may be an alternative to plugging or repair in fragile patients who do not accept the risk of complications with more invasive surgery, and who accept that results may deteriorate over time.

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“…The questionnaire was developed by the senior author, based on their extensive expertise in the diagnosis and management of SCDS with a thorough understanding of the myriad possible presentations and associated symptoms. It has been used in previously published research from our group 12,13 …”

Section: Methodsmentioning

confidence: 99%

“…It has been used in previously published research from our group. 12,13 Audiometric measurements were collected from preand postoperative audiograms. These included: air-bone gap (ABG) at 250, 500, 1000, 2000, and 4000 Hz, puretone average, and cervical vestibular evoked myogenic potential (cVEMP) thresholds at 500, 750, and 1000 Hz.…”

Section: Chart Review and Scds Questionnairementioning

confidence: 99%

Auditory and Vestibular Symptom Improvement With Surgery for Superior Canal Dehiscence Syndrome

Suresh

García

Bartholomew

et al. 2023

Otolaryngol.--head neck surg.

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Objective(1) To measure the change in auditory and vestibular symptoms following superior canal dehiscence (SCD) surgery, and (2) to determine differences in clinical features and surgical outcomes between superior canal dehiscence syndrome (SCDS) patients with primarily auditory or vestibular complaints.Study DesignRetrospective cohort study.SettingSingle surgeon series at the tertiary academic medical center from 2002 to 2021.MethodsRetrospective review of SCDS patients who underwent surgical repair. (1) Patients were administered a standardized symptom questionnaire at preoperative and follow‐up visits, and results were compared with paired statistical testing. (2) Patients were divided into 2 cohorts based on either auditory or vestibular chief complaint and differences in demographic, clinical, and outcome variables were examined.ResultsOur study included 113 patients with 118 operated ears. Twenty‐seven patients (24%) had radiographic bilateral dehiscence. 10/11 auditory symptoms (91%) and 5/8 vestibular symptoms (63%) solicited on the questionnaire improved significantly with surgery, except for nonpulsatile tinnitus, sense of imbalance, positional dizziness, and oscillopsia. Analyses stratified by chief complaint (auditory vs vestibular) revealed overall similar characteristics and surgical outcomes. Patients with chief vestibular complaints underwent surgery at an earlier age (45.5 vs 53.9 years, p < 0.05).ConclusionSCD surgery alleviates a wide range of auditory and vestibular symptoms. Overall, we did not find significant differences between patients with chief auditory versus vestibular complaints, and both groups benefited from surgery. Symptoms are not directly linked to third‐window physiology and certain vestibular symptoms may be more likely to persist. Bilateral dehiscence may play an important role in persistent symptoms as well.

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Superior Canal Dehiscence Surgery Outcomes Following Failed Round Window Surgery

Cited by 16 publications

References 14 publications

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome

Auditory and Vestibular Symptom Improvement With Surgery for Superior Canal Dehiscence Syndrome

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