Superior Canal Dehiscence Treatment & Management

  • Author: Wayne T Shaia, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 30, 2011
 

Surgical Care

Surgical correction of superior canal dehiscence syndrome (SCDS) is reserved for patients with severe disabling symptoms.

Recently, albeit rare, it has been found that children also can have with superior canal dehiscence. They are almost always asymptomatic, and their management is no different from that of adults. Usually, they present with auditory complaints initially, and conservative management is recommended; however, if a child has complaints of vertigo, surgical management may be indicated.[5]

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.[6] 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.[7] 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.

Combination approach

Gianoli and Soileau have advocated a combination approach.[8] 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.

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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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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 School of Medicine; Director of Otology Neurotology and Skull Base Surgery, Providence Hospital; President, Michigan Ear Institute; President, American NeuroMonitoring

Jack M Kartush 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.

Angela Shu-Yuen Peng, MD  Resident Physician, Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University Medical Center

Angela Shu-Yuen Peng, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Virginia Society of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 Unrestricted 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; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Coronal high-resolution computed tomography scan (1-mm sections) that demonstrates the presence of the superior semicircular canal (figure A, black arrow). As the scan is followed posteriorly (figures B, C, D), the bony dehiscence over the superior canal (black arrow) becomes more apparent.
 
 
 
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