Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience

Mozaffari, Khashayar; Ghodrati, Farinaz; Pradhan, Anjali; Ng, Edwin; Ding, Kevin; Rana, Shivam; Duong, Courtney; Anderson, Roan N.; Enomoto, Adam; Sheppard, John P.; Sun, Matthew Z.; Phillips, H. Westley; Yang, Isaac; Gopen, Quinton

doi:10.1016/j.wneu.2021.09.083

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…In children and young adults continuing their education, their academic performance typically drops; they miss days of school and are often assigned a psychiatric or neurobehavioral diagnosis (5)(6)(7)(14)(15)(16). SSCD and other third window syndrome patients with other sites of dehiscence frequently experience migraine headaches as well as the three variants of migraine: ocular migraine [an older term which has been replaced with migraine with aura (bilateral visual field loss) with or without headache], hemiplegic migraine, and vestibular migraine (5-7, [14][15][16][17][18][19]. Retinal migraine (unilateral visual field loss) has not been reported in patients with SSCD or other third window syndrome sites of dehiscence.…”

Section: Introductionmentioning

confidence: 99%

New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

Wackym

Balaban²,

Osch³

et al. 2023

Front. Neurol.

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BackgroundThird window syndrome is a vestibular-cochlear disorder in humans in which a third mobile window of the otic capsule creates changes to the flow of sound pressure energy through the perilymph/endolymph. The nature and location of this third mobile window can occur at many different sites (or multiple sites); however, the most common third mobile window is superior semicircular canal dehiscence (SSCD). There are two essential objective diagnostic characteristics needed to validate a model of SSCD: the creation of a pseudoconductive hearing loss and cVEMP increased amplitude and decreased threshold.MethodsAdult Mongolian gerbils (n = 36) received surgical fenestration of the superior semicircular canal of the left inner ear. ABR and c+VEMP testing were carried out prior to surgery and over acute (small 1 mm SSCD, 1–10 days) or prolonged (large 2 mm SSCD, 28 days) recovery. Because recovery of function occurred quickly, condenser brightfield stereomicroscopic examination of the dehiscence site was carried out for the small SSCD animals post-hoc and compared to both ABRs and c+VEMPs. Micro-CT analysis was also completed with representative samples of control, day 3 and 10 post-SSCD animals.ResultsThe SSCD created a significant worsening of hearing thresholds of the left ear; especially in the lower frequency domain (1–4 kHz). Left (EXP)/right (CTL) ear comparisons via ABR show significant worsening thresholds at the same frequency representations, which is a proxy for the human pseudoconductive hearing loss seen in SSCD. For the c+VEMP measurements, increased amplitude of the sound-induced response (N1 2.5 ms and P1 3.2 ms) was observed in animals that received larger fenestrations. As the bone regrew, the c+VEMP and ABR responses returned toward preoperative values. For small SSCD animals, micro-CT data show that progressive osteoneogenesis results in resurfacing of the SSCD without bony obliteration.ConclusionThe large (2 mm) SSCD used in our gerbil model results in similar electrophysiologic findings observed in patients with SSCD. The changes observed also reverse and return to baseline as the SSCD heals by bone resurfacing (with the lumen intact). Hence, this model does not require a second surgical procedure to plug the SSCD.

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Section: Introductionmentioning

confidence: 99%

New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

Wackym

Balaban²,

Osch³

et al. 2023

Front. Neurol.

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“…Similar findings of less favorable outcomes with revision SCD surgery have been reported. Mozaffari et al ( 66 ) studied 20 patients who underwent revision SCD repair and reported persistent symptoms of vertigo (67%), aural fullness (60%) and dizziness. Sharon et al ( 67 ) evaluated 23 revision cases out of which only 35% of patients reported complete symptom resolution, as compared to ~66% of patients (out of 33) undergoing primary repair ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Benchetrit,

Shave,

Garcia

et al. 2024

Front. Neurol.

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ObjectivePatients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair.Study designRetrospective chart review.SettingTertiary neurotology single-institution care center.Main outcome measuresThe primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups.ResultsOf 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4–28), 1–124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05).ConclusionsSurgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.

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Surgery, Complication, Revisions

Gianoli

2022

Third Mobile Window Syndrome of the Inner Ear

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Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience

Cited by 5 publications

References 33 publications

New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Surgery, Complication, Revisions

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