Canal Dehiscence

[Frédéric]

Since I did not find a thread about "canal dehiscence" in the "Research News" section, I created one. For those who are concerned by canal dehiscence and tinnitus, here is an article to make up your mind before surgery.

Sealing of superior semicircular canal dehiscence is associated with improved balance outcomes postoperatively versus plugging of the canal in middle fossa craniotomy repairs: a case series
DOI: https://doi.org/10.3171/2019.4.JNS19264

OBJECTIVE
The authors compared postoperative symptoms between patients with sealed and those with plugged semicircular canal dehiscence repairs.

METHODS
In total, 136 ears from 118 patients who underwent surgical repair for semicircular canal dehiscence were identified via chart review. Data from postoperative MRI scans showing preservation or loss of semicircular canal fluid signal and postoperative reports of autophony, amplification, aural fullness, tinnitus, hyperacusis, hearing loss, vertigo, dizziness, disequilibrium, oscillopsia, and headache were amalgamated and analyzed.

RESULTS
Patients with preservation of fluid signal were far less likely to have dizziness postoperatively (p = 0.007, OR 0.158, 95% CI 0.041–0.611). In addition, these patients were more likely to have tinnitus postoperatively (p = 0.028, OR 3.515, 95% CI 1.145–10.787).

CONCLUSIONS
The authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging.

SSCD = superior semicircular canal dehiscence

 

[GregCA]

CONCLUSIONS
The authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging.

Ugh... pick your poison: would you like more tinnitus or less balance?

 

[jeff W]

May I ask what your interest in this condition is?

 

[Frédéric]

May I ask what your interest in this condition is?

I personally have no interest, I relayed this information for the benefit of those who are concerned. Canal dehiscence can be a cause of tinnitus.

 

[jeff W]

I personally have no interest, I relayed this information for the benefit of those who are concerned. Canal dehiscence can be a cause of tinnitus.

Refreshing to hear. Do have a look at this similar condition.

 

[Frédéric]

Another article: survey among surgeons.

A Basis for Standardizing Superior Semicircular Canal Dehiscence Management
Ashley C. Cozart, BS1 , John T. Kennedy III, BA1 , and Michael D. Seidman, MD2

Abstract

Objectives: (1) To determine how otologic/neurotologic surgeons counsel patients with superior semicircular canal dehiscence (SSCD). (2) To understand the plethora of presenting symptoms associated with SSCD and appropriate management. (3) To suggest appropriate management; oftentimes avoiding surgery.

Methods: This was a survey study of both community and academic physicians. A 23-question survey was distributed to all members of the American Neurotological (ANS) and American Otologic Societies (AOS) via email in the Fall of 2018. A total of 54 responses were received from a possible pool of 279 for a response rate of 19.4%. Inferences were made about the population through sample proportions and confidence intervals.

Results: All respondents use computed tomography (CT) in diagnosing SSCD and 11.1% use CT exclusively. Cervical vestibular evoked myogenic potential (VEMP; 77.8%) are used more often than ocular VEMPs (38.9%). Magnetic resonance imaging (7.4%) is used infrequently; 96.3% of surgeons surveyed have seen patients with SSCD on imaging that are asymptomatic. Following surgical treatment, respondents reported balance issues and mild-to-moderate high-frequency sensorineural hearing loss (88.4%); 32.6% reported that the majority (>50%) of their patients needed further intervention after surgery, typically aggressive vestibular rehabilitation.

Conclusions: There is a discrepancy in the systematic approach to SSCD between both the surgeons and the published literature. Patients with SSCD on ultra-high-resolution CT may have myriad symptoms while others are asymptomatic, and surgery may lead to additional complications. We will present a methodical recommendation to assist in the management of patients with SSCD depending upon their symptoms. This may improve patient selection, counseling, and outcomes.

Among the data:
"Which of the following symptoms, in isolation, would prompt you to recommend surgical management for SSCD? Select all that apply. (n ¼ 54) Disabling auditory symptoms (pulsatile tinnitus or disabling autophony) 72.22% (39) 95% CI 60.3%-84.2%"