eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Inner Ear

Superior Canal Dehiscence: Follow-up

Author: Wayne T Shaia, MD, Consulting Staff, Department of Otology/Neurotology, Medical College of Virginia
Coauthor(s): Jack M Kartush, MD, Clinical Professor, Department of Otolaryngology, Wayne State University; Director of Otology, Neurotology, and Skull Base Surgery, Providence Hospital; President, Michigan Ear Institute; President, American NeuroMonitoring
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Further Outpatient Care

Patients are monitored based on the intervention and the severity and complexity of the patient's symptoms. Patients who undergo a craniotomy for repair should expect to stay in the hospital for 1-7 days (median 2 d). They may experience imbalance for approximately one month postoperatively.

Prognosis

  • The success rate in the treatment of superior canal dehiscence is quite high. In 2005, a study looked at 20 patients with severe symptoms who underwent surgical repair of their superior canal dehiscence through a middle fossa approach (Gianoli, 2005).7 Canal plugging was performed in 9 patients and a resurfacing technique was performed in 11 patients.
  • Complete resolution of all vestibular symptoms and signs was achieved in 8 of the 9 patients after the canal was plugged. A lower but still significant number of patients with a resurfacing procedure (7 of the 11) had resolution of their vestibular complaints. A total of 15 of the 20 patients (75%) of the patients had resolution of their symptoms after surgical plugging or resurfacing of their dehiscent canal.

Miscellaneous

Medicolegal Pitfalls

  • An estimated 8 million patients annually present to their physician offices with vertigo. Although the identification of superior canal dehiscence syndrome (SCDS) is increasing, SCDS accounts for only a small number of patients with vertiginous symptoms. Thus, the elimination of other, more common, causes of vertigo is necessary before SCDS can be diagnosed.
  • As the recognition of this entity increases, the realization that patients can present with varying degrees of vertigo and hearing loss is becoming apparent. Audiometric testing may reveal a substantial unilateral conductive hearing loss with a narrowing of the air-bone gap at 2000 Hz (Carhart notch), typically associated only with otosclerosis. The noise-induced symptoms may be absent. This clinical presentation is similar to that of otosclerosis, and, consequently, the otologist may recommend surgical correction via stapedectomy. Intraoperative finding of a mobile stapes should raise the suspicion to the otologist of the possibility of SCDS. In addition, patients with persistent air-bone gaps after uneventful stapedectomy may have an unrecognized dehiscence of their superior semicircular canal.
  • In order to prevent unnecessary middle ear exploration, acoustic reflex testing must be performed in all patients with a conductive hearing loss. Acoustic reflexes may be present in early otosclerosis, while reflexes are always present in cases of SCDS. VEMP testing results may be abnormal in SCDS, whereas HRCT is the criterion standard for the diagnosis of SCDS.
 


More on Superior Canal Dehiscence

Overview: Superior Canal Dehiscence
Differential Diagnoses & Workup: Superior Canal Dehiscence
Treatment & Medication: Superior Canal Dehiscence
Follow-up: Superior Canal Dehiscence
Multimedia: Superior Canal Dehiscence
References
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References

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  2. Tsunoda A, Terasaki O. Dehiscence of the bony roof of the superior semicircular canal in the middle cranial fossa. J Laryngol Otol. Jul 2002;116(7):514-8. [Medline].

  3. Brantberg K, Verrecchia L. Testing vestibular-evoked myogenic potentials with 90-dB clicks is effective in the diagnosis of superior canal dehiscence syndrome. Audiol Neurootol. Sep 2009;14(1):54-8. [Medline].

  4. White JA, Hughes GB, Ruggieri PN. Vibration-induced nystagmus as an office procedure for the diagnosis of superior semicircular canal dehiscence. Otol Neurotol. Oct 2007;28(7):911-6. [Medline].

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  6. Kartush JK. Superior Canal Dehiscence Syndrome symptoms resolved by reinforcement of the oval and round windows. Unpublished data. 2002.

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Further Reading

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Keywords

superior canal dehiscence, Hennebert sign, Hennebert's sign, Tullio phenomenon, Tullio's phenomenon, sound-induced vertigo, pressure-induced vertigo, vertigo, dizziness, chronic imbalance, hyperacusis, SCDS, superior canal dehiscence syndrome, vestibular evoked myogenic potentials, VEMPs, hearing loss, dehiscent superior semicircular canal, vestibular symptoms, syphilis, perilymphatic fistula, congenital deafness, Ménière disease, head trauma, Lyme disease, cholesteatomas with labyrinthine fistula, fenestration operations, malpositioned primitive otocyst

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Contributor Information and Disclosures

Author

Wayne T Shaia, MD, Consulting Staff, Department of Otology/Neurotology, Medical College of Virginia
Disclosure: Nothing to disclose.

Coauthor(s)

Jack M Kartush, MD, Clinical Professor, Department of Otolaryngology, Wayne State University; Director of Otology, Neurotology, and Skull Base Surgery, Providence Hospital; President, Michigan Ear Institute; President, American NeuroMonitoring
Jack M Kartush, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, and American Otological Society
Disclosure: Nothing to disclose.

Medical Editor

Robert A Battista, MD, FACS, Assistant Professor of Otolaryngology, Northwestern University Medical School; Physician, Ear Institute of Chicago, LLC
Robert A Battista, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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