Superior semi-circular canal dehiscence syndrome: quantifying the effectiveness of treatment from the patient's perspective

Abstract

Background Superior semi-circular canal dehiscence syndrome is a disorder characterised by auditory and vestibular symptoms that can significantly impact quality of life, and yet it has no disease-specific quality of life instrument. Method Thirty-six patients who underwent transmastoid superior semicircular canal resurfacing and plugging were included from an initial cohort of 60 surgically managed patients. A sub-cohort of 19 consecutive patients completed validated symptom and quality of life questionnaires before and after surgery. Of the 36 patients, 31 participated in a telephone semi-structured interview post-operatively. Results Following surgery, there was a statistically significant improvement in autophony index score (p = 0.02), symptom severity score (p < 0.001) and sound hypersensitivity (p = 0.01). Thematic analysis of telephone interviews suggested three main symptom themes: auditory hypersensitivity, dysequilibrium, headache and concentration difficulties. Dysequilibrium was found to persist post-operatively. Conclusion Surgery improves overall symptoms and quality of life. However, important symptom themes may be overlooked using the outcome measures that are currently available. A unified disease-specific outcome measure is urgently required to better understand the impact of symptoms and measure treatment effects.

Transmastoid Surgery for Superior Canal Dehiscence: Prospective Longitudinal Objective and Patient-Reported Audiovestibular Outcomes

“…In the cohorts of Crane et al (7), Jung et al (6), and de Wolf et al (9), postoperative mean DHI scores were 18 (standard deviation, ±15; range, 0–54), 32 (range, 0–98), and 27 (CI, 19–36). Although both preoperative and postoperative DHI scores in our cohort are lower, two aspects are in line with previous literature: 1) Crane et al did not find significant improvement in DHI scores for patients with preoperative DHI <30, and 2) postoperative, symptoms of dizziness are more prevalent than autophony (6,7,9,10). The DHI is not specific to the third-window produced sound- and pressure-induced dizziness but will also reflect postoperative vestibular dysfunction, explaining persistent dizziness symptoms despite successful repair.…”

“…These included social situations such as being in groups, at a party, or in a restaurant. This is consistent with statements from the semistructured interviews by Mehta et al (10), in which patients expressed complaints like “…couldn't go out with friends as couldn't stand the noise…” and “…avoided social events due to noisy backgrounds….” Hearing thresholds measured as PTA did not change over time from preoperative to postoperative. Underlying single-frequency data do, however, point to improved low-frequency AC thresholds, in accordance with decreased ABG at 250 Hz.…”

“…Over time, from 3-month to 2-year follow-up, there was a statistically significant decline in THI score ( p = 0.01). The median HHI total score improved from 23 (IQR, 12-29) to 9 (1-19) at 1-year follow-up ( p = 0.04; CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. There was no statistically significant change in HHI score over time from the 3-month to 2-year follow-up ( p = 0.73).…”

“…Importantly, the improvement was stable across postoperative follow-ups. In comparison, a comparable study found an improvement from 63 to 31 at 1-year follow-up (10).…”

“…Because the condition is not fatal, it is of particular importance that symptom improvement outweighs the risks of surgery. Most studies report postoperative symptom control based on medical records (1)(2)(3)(4)(5), but recent studies use self-assessment questionnaires and semistructured interviews to quantify and elaborate on the perceived disability after SCD repair (6)(7)(8)(9)(10). These studies suggest that disability from dizziness is more common postoperative than disability from autophony and hearing.…”