Comparison of Outcomes in Superior Canal Dehiscence Surgery Using Either Transmastoid or Middle Fossa Surgical...

ImportanceSuperior semicircular canal dehiscence syndrome (SSCDS) can manifest with significant vestibular and auditory symptoms. For patients with debilitating SSCDS symptoms, surgical repair can be performed using a middle cranial fossa (MCF) or transmastoid (TM) approach, however, comparisons of outcomes between surgical approaches are unclear.ObjectiveTo assess outcomes in SSCD repaired using either MCF or TM surgical approaches.DesignSystematic review and meta-analysis.SettingA systematic search of all articles reporting on the presence of outcomes of SSCD repair in Medline, Embase, CINAHL, Scopus, and Web of Science databases.Participants1130 patients with SSCDS reported in 34 manuscripts.Exposure/InterventionSurgical repair of SSCD via MCF or TM approaches.Main Outcome MeasuresRates of post-operative improvement in subjective auditory and vestibular symptoms as well as changes in objective audiometric measures [air-conduction (AC), bone-conduction (BC), and air-bone gaps (ABG) pure-tone averages].ResultsPatients were highly likely (60%-95%) to report improvement in audiological and vestibular symptom improvement following either technique. No differences were observed between surgical approaches, with the exception of oscillopsia [91.1% vs 61.7%; aOR = 6.40; 95% CI = (1.66-24.66); P = .007]. No significant post-operative objective changes in audition were observed (AC thresholds, BC thresholds or ABG).ConclusionOutcomes of SSCD surgery are excellent. Most patients report significant improvement or resolution of their pre-operative symptoms, with only minor differences in symptom resolution observed across approaches.RelevanceOur results provide evidence that surgical correction of SSCD through MCF and TM approaches is effective. supporting individualized decision-making based on surgeon experience and patient factors.