Vestibular rehabilitation following surgical repair for Superior Canal Dehiscence Syndrome: A complicated case report

Abstract

Superior Canal Dehiscence Syndrome (SCDS) causes auditory and vestibular symptoms. Following surgical repair of the dehiscence, patients often experience dizziness and imbalance. This case report describes a postoperative vestibular exercise program, focusing on the principles of central compensation and habituation, and how it was modified for a patient with delayed progress secondary to strabismus and visual vertigo. A 63-year-old male with history of strabismus eye surgery, right hearing loss, aural fullness, and sensitivity to loud sounds was referred for vestibular rehabilitation (VR). He was seen for one preoperative and six postoperative PT visits over eight months. Outcome measures two weeks postoperative were as follows: Dizziness Handicap Inventory (DHI) 38/100; Timed Up & Go (TUG) 9.92 seconds; Dynamic Gait Index (DGI) 16/24; and a 3-line difference in Dynamic Visual Acuity (DVA). Improved outcomes at discharge included: DHI 18/100; TUG 6.87 seconds; DGI 23/24; and 1-line difference in DVA. He was able to return to work and previously enjoyed recreational activities. Postoperative vestibular rehabilitation programs are functionally and symptomatically beneficial following surgical repair for SCDS. Deviations from expected recovery should be addressed to achieve optimal outcomes as demonstrated in this complicated case report.

Role of Vestibular Rehabilitation in Patients with Superior Semicircular Canal Dehiscence Syndrome

“…Fenestration or removal of the stapedial footplate could transfer some abnormal energy to the inner ear and could increase the higher risk of inner ear damage during operation. Vestibular rehabilitation following surgical repair focusing on central compensation and habituation is needed [16,17]. Patients may be advised about risks and may avoid surgery, preferring instead the use of hearing aids.…”

“…Dizziness after SDSC surgery is not commonly reported on the literature, nevertheless objective measures such as Dynamic gait index, dynamic visual acuity and subjective measures such as Dizziness Handicap Inventory are crucial in order to accurately evaluate our patients pre and post surgery [11]. Follow up using these same measures is capital.…”

“…Additionally, vestibular rehabilitation focusing on central compensation and habituation is recommended [16,17].…”

“…We must be able to communicate these considerations to the patient to provide proper counselling. Specific interventions included vestibular habituation and adaptation exercises, balance and gait training, and patient education is needed [11].…”

Biomechanics of Third Window Syndrome

“…Compensatory vestibular-ocular reflexes (86) and dynamic visual acuity (92) do not fully recover. Vestibular physical therapy is useful in the postoperative period to aid in recovery (91,93). In animal models, canal plugging impairs the low frequency VOR and profoundly reduces single unit afferent sensitivity to lowfrequency head rotations (>100 fold), but introduces only modest attenuation for high-frequency head rotations (>10 Hz) (94)(95)(96).…”