Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension

Berkıten, Güler; Gürbüz, Defne; Akan, Onur; Tutar, Belgın; Tunç, Melis Koşar; Karaketir, Semih; Bircan, Hasan Sami; Berkiten, Ertan; Sarı, Hüseyin; Atar, Yavuz; Uyar, Yavuz

doi:10.1007/s00405-021-07020-z

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…Due to prior research we were interested in the evaluation of persistent SCDS symptomatology with elevated BMI; however an association was not identified in our study ( 45 , 46 ). Prior research has generally shown association of elevated BMI with sensorineural hearing loss (SNHL), and in the context of skull base defects, elevated BMI has been used as a surrogate indicator of elevated intracranial pressure ( 47 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

“…The increased intracranial hypertension is hypothesized to lead to erosion of the skull base from direct repeated pulsations of the dura over time ( 51 ). With regards to SCDS, this erosion may thin the bone over the superior canal, thereby causing symptoms related to SCDS ( 46 ). While our study did not identify a significant difference, we had a relatively small cohort of patients with elevated BMI (17.5%, n = 22), and further research will assist to confirm or dispute the association in order to improve patient counseling.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Benchetrit,

Shave,

Garcia

et al. 2024

Front. Neurol.

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ObjectivePatients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair.Study designRetrospective chart review.SettingTertiary neurotology single-institution care center.Main outcome measuresThe primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups.ResultsOf 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4–28), 1–124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05).ConclusionsSurgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Benchetrit,

Shave,

Garcia

et al. 2024

Front. Neurol.

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“…Naturally, the same mechanism has been proposed to occur at the bone overlying the superior canal, leading eventually to SSCD (9). Patients with IIH were found to have thinner bone overlying the superior canal compared with control patients and a higher rate of SSCD (10).…”

Section: Introductionmentioning

confidence: 99%

Matched Cohort Study of Radiographic Superior Semicircular Canal Dehiscence and Tegmen Dehiscence and Obstructive Sleep Apnea

Kaufman

Cooperman²,

Ali³

et al. 2022

Otol Neurotol

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Objective: To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA). Study Design: Retrospective matched cohort study. Setting: Tertiary care center. Patients: Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded. Main Outcome Measures: Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers. Results: The average body mass index of the OSA patients was 29.2 kg/m 2 with an average apnea-hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m 2 . Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group ( p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group ( p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence. Conclusion:The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from ageand sex-matched controls. This is in contrast to a previous casecontrol study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.

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Surgery, Complication, Revisions

Gianoli

2022

Third Mobile Window Syndrome of the Inner Ear

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Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension

Cited by 10 publications

References 18 publications

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome

Matched Cohort Study of Radiographic Superior Semicircular Canal Dehiscence and Tegmen Dehiscence and Obstructive Sleep Apnea

Surgery, Complication, Revisions

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