Assessment of superior semicircular canal thickness with advancing age
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Objective To determine whether superior semicircular canal dehiscence (SSCD) is more prevalent with advancing age. Study Design Retrospective observational study. Methods High‐resolution computed‐tomographic temporal bone scans were identified for patients of all ages and analyzed by two independent assessors. Multiplanar reconstruction was applied, and the thinnest area of temporal bone overlying each superior semicircular canal (SSC) was measured. Results A sample of 121 patients was analyzed that contained an almost identical number of male and female patients. In total, 242 temporal bone images were reviewed. Patients' ages ranged between 6 and 86 years. Age was shown to have a significant linear relationship ( P < 0.001) such that for every unit increase in age the predicted thickness was reduced by 0.0047 mm. Conclusions The thickness of the SSC decreases with advancing age. Level of Evidence 4. Laryngoscope , 125:1940–1945, 2015Keywords:
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Posterior Semicircular Canal
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Superior semicircular canal dehiscence (SSCD) is characterized by lack of bony covering of the superior semicircular canal in the inner ear, resulting in a third mobile window with altered functioning of the superior semicircular canal. Vertigo in association with sound and pressure changes often occurs. This study examines the relationship between dehiscence size and frequency of sound-induced vertigo.Retrospective review of 22 patients with SSCD, noting the auditory frequency producing the maximal electronystagmographic response.The study found a correlation between dehiscence size and stimulator frequency of r = 0.856, p < 0.001. The larger the dehiscence, the lower the frequency of stimuli required to provoke a vestibular response.The relationship found between the superior canal dehiscence size and the stimulator frequency has clinical implications in the diagnosis and management of patients with SSCD.
Otologic Surgical Procedures
Posterior Semicircular Canal
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Semicircular canal dehiscence is a congenital syndrome that mainly affects the superior and, less commonly, the posterior semicircular canals. The diagnosis of superior semicircular canal dehiscence syndrome depends on the demonstration of a very small defect in the bony wall of the superior semicircular canal. Any amount of intact bone present excludes the diagnosis. The study will give an approximation of the incidence of semicircular canal dehiscence in Singapore. No specific data regarding the number of such cases exist currently. Retrospective review of CT scans of the temporal bone performed at our institution between January 2005 and July 2007 revealed a total of 10 such cases over this period, comprising 8 males and 2 females, with all cases involving the superior semicircular canal. Almost all of the patients scanned had evidence of previous or existing cholesteatoma. Three patients had bilateral superior semicircular canal dehiscence (all males), with an almost equal number of semicircular canal dehiscence on both sides for both sexes. Our study shows no significant advantage to obtaining reformatted oblique sagittal images for all temporal bone studies, unless the visualized walls show questionable defects. In these cases, reconstructed images are probably advantageous and should be obtained and reviewed.
Posterior Semicircular Canal
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Abstract Objectives To present a histopathological case of a 91‐year‐old woman who was diagnosed with superior semicircular canal dehiscence postmortem. Methods The patient was a registered donor with the National Temporal Bone Donor Program at the NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry. Computed tomography imaging was performed on each temporal bone. The temporal bones were decalcified with ethylenediaminetetracetate and embedded in celloidin, and tissue sections were stained with hematoxylin and eosin. Horizontal sections were taken through the left temporal bone, and vertical sections were taken through the right temporal bone. Results Histopathological sections taken through the right temporal bone demonstrated no bone between the membranous wall of the superior semicircular canal and the middle fossa dura. There was no histopathological evidence of superior semicircular canal dehiscence in the left temporal bone; however, a small dehiscence would not be identified on horizontal sections. Microcavitations were observed in the common crus of the left temporal bone. Conclusion This reports describes the case of a woman who was diagnosed with superior semicircular canal dehiscence postmortem. The presence of microcavitations in the temporal bone is consistent with osteoclastic activity, which may play a role in the development of superior canal dehiscence.
Middle cranial fossa
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Objective: This report describes a case of development of radiologic superior semicircular canal dehiscence and reviews the literature for pertinent clinical and radiologic findings in patients with superior semicircular canal dehiscence syndrome (SCDS). Patient: A 28-year-old man presented with auditory and vestibular symptoms of SCDS and underwent a high-resolution temporal bone computed tomography scan that showed frank dehiscence of the right superior semicircular canal. Diagnosis of SCDS was further verified with audiometric and cervical vestibular-evoked myogenic potential (cVEMP) thresholds. The patient had previously undergone a computed tomography scan 12 years prior for work-up of sudden sensorineural hearing loss that showed no evidence of superior semicircular canal dehiscence bilaterally. Interventions: A combination of diagnostic and therapeutic interventions was conducted consisting of preoperative audiometric and cVEMP thresholds, followed by middle fossa craniotomy for surgical repair of the dehiscence. Main Outcome Measure: Postoperative audiometric and cVEMP thresholds and symptomatic improvement of SCDS after surgical repair of the dehiscence. Results: The patient reported resolution of his clinical symptoms after surgical repair of the dehiscence. Postoperative cVEMP thresholds improved to the normal range and the mild low-frequency conductive hearing loss resolved. Conclusions: To our knowledge, this case report is the first description of radiologically proven new development of superior canal dehiscence. Further prospective studies that include serial imaging examinations may help with visualizing and understanding the temporal evolution of superior canal dehiscence, and better elucidate the relationship between development/ progression of superior canal dehiscence and onset of clinical symptoms.
Conductive hearing loss
Posterior Semicircular Canal
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To evaluate the clinical application of multi-planar reformation (MPR) for the diagnosis of superior semicircular canal dehiscence syndrome.A retrospective study was conducted on 9 patients who were diagnosed with SSCD syndrome in the Otology and Skull Base Surgery group of Fudan University. Three radiologists analyzed all the patients' 0.75 mm-collimated axial and coronal images and 0.75 mm-collimated MPR images, and they came up with the same results.There were 18 superior semicircular canal in the 9 patients, of whom 9 were intact and 9 were defective. All the defective superior semicircular displayed a definite dehiscence in all the MPR images, which indicated the sensitivity was 100%; however, 7 of the 9 defective superior semicircular canal were diagnosed as dehiscence in axial images, while 8 of the 9 were diagnosed in coronal images, but the sensitivities were 77.8% and 88.9% respectively. The results of the other 9 with intact superior semicircular canal displayed in the MPR, axial, and coronal images were also different. In the MPR images, they all displayed definite intact roof over the superior semicircular canal. There were 2 dehiscence in all axial and coronal images, and the specificities were 77.8%.The MPR image is more useful in diagnosis of superior semicircular canal dehiscence syndrome than that of the routine axial and coronal images.
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Abstract Objective Tegmen tympani dehiscence in temporal multidetector computed tomography (MDCT) and superior semicircular canal dehiscence may be seen together. We investigated superior semicircular canal dehiscence in temporal MDCT and temporal magnetic resonance imaging (MRI). Methods In this retrospective study, 127 temporal MRI and MDCT scans of the same patients were reviewed. In all, 48.8% (n = 62) of cases were male, and 51.2% (n = 65) of cases were female. Superior semicircular canal dehiscence and superior semicircular canal-temporal lobe distance were evaluated by both MDCT and MRI. Tegmen tympani dehiscence was evaluated by MDCT. Results Superior semicircular canal dehiscence was detected in 14 cases (5.5%) by temporal MDCT and 15 cases (5.9%) by temporal MRI. In 13 cases (5.1%), it was detected by both MDCT and MRI. In one case (0.4%), it was detected by only temporal MDCT, and in two cases (0.8%), it was detected by only temporal MRI. Median superior semicircular canal-to-temporal distance was 0.66 mm in both males and females in temporal MDCT and temporal MRI. In both temporal MDCT and temporal MRI, as superior semicircular canal-to-temporal lobe distance increased, the presence of superior semicircular canal dehiscence in temporal MDCT and temporal MRI decreased. Tegmen tympani dehiscence was detected in eight cases (6.3%) on the right side and six cases (4.7%) on the left side. The presence of tegmen tympani dehiscence in temporal MDCT and the presence of superior semicircular dehiscence in MDCT and MRI increased. Conclusion Superior semicircular canal dehiscence was detected by both MDCT and MRI. Due to the accuracy of the MRI method to detect superior semicircular dehiscence, we recommend using MRI instead of MDCT to diagnose superior semicircular canal dehiscence. Moreover, there is no radiation exposure from MRI.
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The enhanced sound- and vibration-induced vestibular evoked myogenic potentials (VEMPs) and their lower threshold in patients with a thinning of the bony wall of the superior semicircular canal (superior canal dehiscence, SCD) have been interpreted as being due to the dehiscence allowing sound and vibration to activate, unusually, the receptors of the dehiscent semicircular canal. We report a patient with bilateral SCD, as verified by high resolution CT scans, who had bilaterally decreased superior semicircular canal function, as shown by rotational tests of canal function. This patient also showed enhanced VEMPs and reduced thresholds. We conclude that in this patient the enhanced VEMP responses are thus probably due to enhanced otolithic stimulation by sound and vibration after dehiscence.
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We report on the presentation and clinical manifestations of superior semicircular canal dehiscence in association with a large defect of the tegmen tympani in a 41-year-old woman with no previous history of trauma. Based on this case we recommend that clinicians consider the possibility of superior semicircular canal dehiscence in patients presenting with symptoms associated with tegmen defects.
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Abstract Objective To describe a case of asymptomatic superior semicircular canal dehiscence. Method Clinical case report. Results A 50-year-old man presenting with right-sided Ménière´s disease also showed an enhanced response on vestibular evoked myogenic potential testing for the left ear. Unilateral left-sided superior semicircular canal bone dehiscence was clearly visualised on a subsequent temporal bone computed tomography scan. These findings were consistent with superior canal dehiscence syndrome. However, the patient did not complain of any specific superior canal dehiscence syndrome symptoms. Given that vestibular evoked myogenic potential testing may detect asymptomatic forms of superior canal dehiscence, as noted in this case, such testing seems to exhibit reduced specificity for superior canal dehiscence syndrome. Conclusion An enhanced response on vestibular evoked myogenic potential testing in isolation appears to be a weaker indicator of superior canal dehiscence syndrome, and rather a marker of superior semicircular canal dehiscence.
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