Outcomes of Transmastoid Surgery for Superior Semicircular Canal Dehiscence Syndrome

Powell, Heather; Khalil, S. Abi; Saeed, Shakeel R

doi:10.1097/mao.0000000000001103

Cited by 25 publications

(27 citation statements)

References 15 publications

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“…Several meta‐analyses have examined the surgical complications related to SSCD treatment. No significant differences in outcomes or complications were found between resurfacing and plugging, whether through a transmastoid or middle cranial fossa approach . Vestibular hypofunction was only seen in one of 12 (8%) ears in our study.…”

Section: Discussioncontrasting

confidence: 55%

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

2019

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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

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Section: Discussioncontrasting

confidence: 55%

“…Most recently, Powell et al reported on their experience with transmastoid resurfacing with bone paté and fibrin sealant . Here, success was defined by an improvement in symptoms and quality of life, and the authors found significant improvements in 6 of 9 symptoms; most patients reported that the surgery improved their quality of life …”

Section: Introductionmentioning

confidence: 99%

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

2019

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“…Resurfacing material also varies and can include cartilage, fascia, bone dust, fibrin glue, and hydroxyapatite cement. The transmastoid approach to plugging the canal has also been used in many cases with excellent results (38, 90–92). Prior to pursuing surgery, however, control of migraine is critical to avoid exacerbation of migraine after surgery and to distinguish treatable symptoms that are unlikely to be helped by repairing a dehiscence.…”

Section: Treatmentmentioning

confidence: 99%

“…We feel a significant disadvantage of the transmastoid approach is the lack of directly seeing the dehiscence, thereby risking inadequate plugging on either side of the dehiscence. Some have suggested this can be circumvented by elevating dura over the dehiscence via the mastoid and using a mirror to ensure the canal is adequately plugged (92). …”

Section: Treatmentmentioning

confidence: 99%

Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years

2017

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Superior semicircular canal dehiscence syndrome was first reported by Lloyd Minor and colleagues in 1998. Patients with a dehiscence in the bone overlying the superior semicircular canal experience symptoms of pressure or sound-induced vertigo, bone conduction hyperacusis, and pulsatile tinnitus. The initial series of patients were diagnosed based on common symptoms, a physical examination finding of eye movements in the plane of the superior semicircular canal when ear canal pressure or loud tones were applied to the ear, and high-resolution computed tomography imaging demonstrating a dehiscence in the bone over the superior semicircular canal. Research productivity directed at understanding better methods for diagnosing and treating this condition has substantially increased over the last two decades. We now have a sound understanding of the pathophysiology of third mobile window syndromes, higher resolution imaging protocols, and several sensitive and specific diagnostic tests. Furthermore, we have a treatment (surgical occlusion of the superior semicircular canal) that has demonstrated efficacy. This review will highlight some of the fundamental insights gained in SCDS, propose diagnostic criteria, and discuss future research directions.

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“…Early feasibility studies on hearing preservation after canal plugging were observed by Parnes and McClure among guinea pigs [Parnes and McClure, 1985]. Among human-beings, the preservation of hearing thresholds has been observed in patients undergoing canal plugging of the posterior canal through the transmastoid approach and the superior canal by the middle cranial fossa approach [Agrawal and Parnes, 2001;Banakis Hartl and Cass, 2018;Beyea et al, 2012;Lundy et al, 2011;Niesten et al, 2013;Powell et al, 2016;Van Haesendonck et al, 2016;Yamauchi et al, 2017] as well as the superior canal by middle cranial fossa approach [Ward et al, 2012]. Generally, surgery has a positive impact of the symptoms of SCDS.…”

Section: Introductionmentioning

confidence: 99%

Hearing Outcomes after Transmastoid Plugging of Superior Canal Dehiscence

Wilms¹,

Ernst²,

Mittmann³

2018

Audiol Neurotol

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Background: Patients with a superior canal dehiscence syndrome display symptoms of the vestibular disorder except that of hearing loss. Therefore, any type of surgery should treat those symptoms without affecting the hearing threshold. The aim of this study was to evaluate the extent to which the hearing threshold has been affected; the evaluation process was carried out by a transmastoid plugging of the superior canal. Another aim was to estimate the risk in loss of hearing due to this surgery. Material and Methods: In a retrospective study, 31 patients with dehiscence of the superior canal, who underwent a transmastoid plugging, were included. Additionally, 8 of them with the clinical symptoms of the Menière’s disease received an endolymphatic sac surgery. A b-c threshold at 0.25, 0.5, 1, 2, and 4 kHz was observed in all patients pre and postoperatively as well as in the long-term follow-up. Results: After a mean interval of 149 days, a change in the b-c threshold of 5.9 dB was detected. After 149 days, in the patient group comprising those who underwent an additional endolymphatic sac surgery, a b-c threshold change of 17.18 dB was detected. Conclusion: The transmastoid plugging of the superior semicircular canal can be performed with an acceptable risk of hearing affection. If the surgery was combined with other techniques, (e.g. endolymphatic sac surgery) then the risk increases.

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Outcomes of Transmastoid Surgery for Superior Semicircular Canal Dehiscence Syndrome

Cited by 25 publications

References 15 publications

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

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

Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years

Hearing Outcomes after Transmastoid Plugging of Superior Canal Dehiscence

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