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A Basis for Standardizing Superior Semicircular Canal Dehiscence Management
Ashley C Cozart1, John T Kennedy1, Michael D Seidman2
1University of Central Florida (UCF) College of Medicine, Orlando, FL, USA.
Ear, Nose, & Throat Journal
|May 22, 2020
Summary
Surgeons show varied approaches to superior semicircular canal dehiscence (SSCD) management. Many patients with SSCD on imaging are asymptomatic, and surgery can lead to complications, suggesting a need for improved patient selection and counseling.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Superior semicircular canal dehiscence (SSCD) is a condition with diverse symptoms and varied surgical and non-surgical management strategies.
- Current approaches to counseling and managing SSCD patients lack standardization among otologic/neurotologic surgeons.
- Understanding symptom presentation and optimizing management, potentially avoiding surgery, are crucial for patient care.
Purpose of the Study:
- To investigate how otologic/neurotologic surgeons counsel patients diagnosed with SSCD.
- To delineate the range of symptoms associated with SSCD and determine current management practices.
- To propose evidence-based recommendations for SSCD management, emphasizing non-surgical options where appropriate.
Main Methods:
- A survey study was conducted among community and academic physicians.
- A 23-question survey was emailed to members of the American Neurotological (ANS) and American Otologic Societies (AOS).
- Data from 54 respondents (19.4% response rate) were analyzed to infer population trends.
Main Results:
- Computed tomography (CT) is universally used for SSCD diagnosis, with 11.1% relying on CT exclusively.
- Cervical vestibular evoked myogenic potential (VEMP) testing (77.8%) is more common than ocular VEMPs (38.9%).
- A significant majority of surgeons (96.3%) have encountered asymptomatic SSCD cases on imaging, and post-surgical complications like balance issues and hearing loss are reported, with many patients requiring further intervention.
Conclusions:
- A notable discrepancy exists in the systematic management of SSCD between surgeons and existing literature.
- SSCD diagnosis via ultra-high-resolution CT can reveal asymptomatic cases, highlighting the risks of surgical intervention.
- Methodical recommendations are proposed to guide patient selection, counseling, and improve outcomes for SSCD management.
