eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Inner Ear

Superior Canal Dehiscence: Treatment & Medication

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

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.

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

  1. Minor LB. Superior canal dehiscence syndrome. Am J Otol. Jan 2000;21(1):9-19. [Medline].

  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].

  5. Brantberg K, Bergenius J, Mendel L, Witt H, Tribukait A, Ygge J. Symptoms, findings and treatment in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol. Jan 2001;121(1):68-75. [Medline].

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 Unpublished data. 2002.

  7. Gianoli GJ, Soileau JS. The dehiscent middle fossa: prevalence, manifestations, associated findings and results of 24 surgical explorations for superior semicircular canal dehiscence. Publication pending: presented as triologic thesis, 2005.

  8. Banerjee A, Whyte A, Atlas MD. Superior canal dehiscence: review of a new condition. Clin Otolaryngol. 2005;Feb 30(1):9-15. [Medline].

  9. Brantberg K, Ishiyama A, Baloh RW. Drop attacks secondary to superior canal dehiscence syndrome. Neurology. Jun 28 2005;64(12):2126-8. [Medline].

  10. Carey JP, Minor LB, Nager GT. Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg. 2000;Feb;126(2):137-47. [Medline].

  11. Cremer PD, Minor LB, Carey JP, Della Santina CC. Eye movements in patients with superior canal dehiscence syndrome align with the abnormal canal. Neurology. 2000;55:1833-41. [Medline].

  12. Deutschländer A, Strupp M, Jahn K, Jäger L, Quiring F, Brandt T. Vertical oscillopsia in bilateral superior canal dehiscence syndrome. Neurology. Mar 9 2004;62(5):784-7. [Medline].

  13. Friedland DR, Wackym PA. A critical appraisal of spontaneous perilymphatic fistulas of the inner ear. Am J Otol. 1999;20:261-276. [Medline].

  14. Hennebert C. A new syndrome in hereditary syphilis of the labyrinth. Presse Med Belg Brux. 1911;63:467.

  15. Hillman TA, Kertesz TR, Hadley K, Shelton C. Reversible peripheral vestibulopathy: the treatment of superior canal dehiscence. Otolaryngol Head Neck Surg. Mar 2006;134(3):431-6. [Medline].

  16. Martin JE, Neal CJ, Monacci WT, Eisenman DJ. Superior semicircular canal dehiscence: a new indication for middle fossa craniotomy. Case report. J Neurosurg. Jan 2004;100(1):125-7. [Medline].

  17. Merchant SN, Rosowski JJ, McKenna MJ. Superior semicircular canal dehiscence mimicking otosclerotic hearing loss. Adv Otorhinolaryngol. 2007;65:137-45. 2007;65:137-45. [Medline].

  18. Mikulec AA, McKenna MJ, Ramsey MJ, Rosowski JJ, Herrmann BS, Rauch SD. Superior semicircular canal dehiscence presenting as conductive hearing loss without vertigo. Otol Neurotol. Mar 2004;25(2):121-9. [Medline].

  19. Mikulec AA, Poe DS, McKenna MJ. Operative management of superior semicircular canal dehiscence. Laryngoscope. 2005;Mar 115(3):501-7. [Medline].

  20. Minor LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope. 2005;Oct 15(10):1717-27. [Medline].

  21. Minor LB, Carey JP, Cremer PD, Lustig LR, Streubel SO, Ruckenstein MJ. Dehiscence of bone overlying the superior canal as a cause of apparent conductive hearing loss. Otol Neurotol. Mar 2003;24(2):270-8. [Medline].

  22. Minor LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope. 2005;Oct;115(10):1717-27. [Medline]. [Full Text].

  23. Ostrowski VB, Byskosh A, Hain TC. Tullio phenomenon with dehiscence of the superior semicircular canal. Otol Neurotol. Jan 2001;22(1):61-5. [Medline].

  24. Smullen JL, Andrist EC, Gianoli GJ. Superior semicircular canal dehiscence: a new cause of vertigo. J La State Med Soc. Aug 1999;151(8):397-400. [Medline].

  25. Streubel SO, Cremer PD, Carey JP, Weg N, Minor LB. Vestibular-evoked myogenic potentials in the diagnosis of superior canal dehiscence syndrome. Acta Otolaryngol Suppl. 2001;545:41-9. [Medline].

  26. Teixido MT, Artz GJ, Kung BC. Clinical experience with symptomatic superior canal dehiscence in a single neurotologic practice. Otolaryngol Head Neck Surg. Sep 2008;139(3):405-13. [Medline].

  27. Tullio P. Das Ohr und die Entstehung der Sprache und Schrift Berlin. Urban & Schwarzenberg,. 1929.

  28. [Best Evidence] [Guideline] Vlastarakos PV, Proikas K, Tavoulari E, Kikidis D, Maragoudakis P, Nikolopoulos TP. Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies. Eur Arch Otorhinolaryngol. FEB;266(2):177-86. [Medline].

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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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