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Superior Canal Dehiscence: Treatment & Medication
Updated: Sep 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Surgical Care
Surgical correction of superior canal dehiscence syndrome (SCDS) is reserved for patients with severe disabling symptoms. The treatment options for patients with SCDS are still expanding, with new innovative methods under development.
- Middle fossa craniotomy and repair of fistula: In this procedure, patients undergo a middle cranial fossa craniotomy on the affected side. The temporal lobe is gently retracted. Upon elevation of the dura, care is required to avoid stretching the greater superficial petrosal nerve, which could injure the facial nerve. The region of the superior semicircular canal is located with identification of the arcuate eminence. A dehiscence of the superior semicircular canal can be covered with bone wax, bone cement, or fascia, or the canal can be ablated with wax or bone cement. Current evidence suggests that ablation gives better long-term results.
- Transmastoid superior canal occlusion: In this approach, a mastoidectomy is performed and the superior semicircular canal is identified near the ossicular heads. The superior semicircular canal is then ablated with a combination of tissue and fascia. Brantberg et al performed a superior canal–plugging procedure via a transmastoid approach in 2 patients.5 Postoperatively, sound- and pressure-induced symptoms and nystagmus were resolved in response to offending stimuli. Although this approach can be effective, the risk of sensorineural hearing loss increases with this procedure because of limited exposure versus middle fossa craniotomy.
- Minimally invasive approach via transcanal oval and round window reinforcement
- The optimal surgical treatment of superior canal dehiscence syndrome has yet to be determined. Rather than directly addressing the dehiscent canal via a middle fossa craniotomy, Kartush (2002) suggested that dampening the inner ear's sensitivity by reinforcing the oval and round windows may alleviate symptoms in some patients.6 The concept is to reduce the effects of a third window at the superior semicircular canal by reinforcing the other 2 natural windows. By dampening the hypercompliance of the inner ear at the oval and round windows, rather than intracranially, the risks of craniotomy, which include death, stroke, cranial palsies, and cerebrospinal fluid leaks, are avoided.
- Symptoms resolved in 2 patients with SCDS treated with transcanal reinforcement of the oval and round windows. If such a minimally invasive procedure proves helpful, middle fossa craniotomy with resurfacing of the canal could then be reserved for patients with persistent symptoms.
- Under local anesthesia, a transcanal approach to the middle ear is performed with elevation of the tympanic membrane. Small amounts of fascia are harvested from a postauricular incision and are used to reinforce both the oval and round windows. The postoperative risk of hearing loss and facial nerve injury is minimal. This procedure can be performed on an outpatient basis.
- Gianoli and Soileau have advocated a combination approach.7 In this technique, the superior canal defect is repaired via the middle fossa approach with concomitant reinforcement of the oval and round windows. The authors claim improved outcomes over middle fossa repair alone, reporting a resolution of vertigo in 24 cases with a 5-year follow-up period.
Consultations
Consultation with an otologist or neurootologist should be obtained in any patient with symptoms that coincide with superior canal dehiscence.
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| Overview: Superior Canal Dehiscence |
| Differential Diagnoses & Workup: Superior Canal Dehiscence |
Treatment & Medication: Superior Canal Dehiscence |
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References
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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].
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].
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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Further Reading
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
Treatment & Medication: Superior Canal Dehiscence