Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique

Abstract

Objective Superior semicircular canal dehiscence is a well‐described syndrome with potentially debilitating symptoms. We report on the audiologic and long‐term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique. Methods Retrospective chart review and cross‐sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used. Nonlinear regression curves of pre‐/postoperative air and bone pure‐tone audiometric data were used to evaluate postoperative changes in hearing. Surgical failure was defined as requiring revision surgery, and rates were estimated over time using a Kaplan‐Meier analysis. Results Most patients reported improved symptoms postoperatively and were satisfied overall with the surgical outcomes. However, four of 12 ears (33%) had a second (revision) surgery before achieving these results. Postoperatively, hearing through air and bone conduction tended to decrease at frequencies greater than 2500 Hz. The chance of avoiding a re‐operation at 36 months (and up to 120 months) was estimated to be 57.1% (95% confidence interval [confidence interval]: 100%, 32.6%). The most common surgical complication was intraoperative cerebrospinal fluid (CSF) leak, encountered exclusively during dural elevation, seen in four of 12 ears (33%). Conclusion Although subjectively successful at reducing symptoms, in our small sample this surgical approach did not provide a long‐term stable repair and was frequently associated with intraoperative CSF leak. Offering transmastoid resurfacing to patients should involve a detailed discussion on the potential for revision surgery and risks of diminished hearing and CSF leak. Level of Evidence 4 Laryngoscope, 129:2164–2169, 2019

Spontaneous Tegmen Tympani Dehiscence: Causes and Treatment of Conductive Hearing Loss

“…Although an accompanying improvement in low-frequency AC is often said to result in a decrease in, or even closure of the ABG, substantial interpatient variability has been documented. A significant proportion of patients have a persistent or even increased ABG >1 month postoperatively (31–34). In our series the ABG closed in only one ear (ear 7).…”

Superior Semicircular Canal Dehiscence

“…En sık görülen komplikasyon ise dural elevasyon sırasında dört kulakta beyin omurilik sıvısı sızıntısıdır. 32 Yapılan başka bir çalışmada, SSKD hastalarında transmastoid olarak kanal tıkanma işlemi uygulanmıştır. Hastalarda işitme sonuçlarının çok iyi olduğu ve otolojik semptomların düzeldiği görülmüştür.…”

Ambient Pressure Tympanometry Wave Patterns in Patients With Superior Semicircular Canal Dehiscence

“…Due to a third mobile window effect, patients can present with vestibular and auditory symptoms, including autophony, aural fullness, sound-induced vertigo, pulsatile tinnitus, and hearing loss (1,(8)(9)(10). Surgical intervention provides partial or complete symptom resolution in up to 70% of patients (11)(12)(13)(14)(15). However, diagnosis is complicated by the variable presentation of SSCD, which may resemble otosclerosis and Meniere's disease (16,17).…”