Abstract
Superior canal dehiscence syndrome (SCDS) can be treated surgically in patients with incapacitating symptoms. However, the ideal treatment has not been determined. This systematic literature review aims to assess available evidence on the comparative effectiveness and risks of different surgical treatments regarding: (1) symptom improvement; (2) objectively measurable auditory and vestibular function; (3) adverse effects, and (4) length of hospitalization. A systematic database search according to PRISMA statement was conducted on Pubmed, Embase, and Cochrane library. In addition, reference lists were searched. No correspondence with the authors was established. The last search was conducted on June 9, 2017. Retrospective and prospective cohort studies were held applicable under the condition that they investigated the association between a surgical treatment method and the relief of vestibular and/or auditory symptoms. Only studies including quantitative assessment of the pre- to postoperative success rate of a surgical treatment method were included. Case reports, reviews, meta-analysis, and studies not published in English, Dutch, or German were excluded. The first author searched literature and extracted data; the first and last analyzed the data. Seventeen studies (354 participants, 367 dehiscences) met the eligibility criteria and were grouped according to surgical approach. Seven combinations of surgical approaches and methods for addressing the dehiscence were identified: plugging, resurfacing, or a combination of both through the middle fossa (middle fossa approach); plugging, resurfacing, or a combination of both through the mastoid (transmastoid approach); round window reinforcement through the ear canal (transcanal approach). Several studies showed high internal validity, but quality was often downgraded due to study design (1). Outcome measures and timing of postsurgical assessment varied among studies, making it unfeasible to pool data to perform a meta-analysis. A standardized protocol including outcome measures and timeframes is needed to compare the effectiveness and safety SCDS treatments. It should include symptom severity assessments and changes in vestibular and auditory function before and after treatment.
Highlights
RationaleReason for Conducting This ResearchSuperior canal dehiscence syndrome (SCDS) is a rare condition in which a hole in the superior semicircular canal causes sound and pressure waves to evoke vestibular and auditory symptoms
Improvement and resolution of hyperacusis were not assessed following round window reinforcement. Taking these results into account, no comparison could be made among the different approaches; bone conduction (BC) hyperacusis was often resolved by transmastoid plugging
Plugging or plugging and resurfacing the dehiscence using the middle fossa or transmastoid approach as well as round window reinforcement led to significant improvements of autophony symptoms
Summary
RationaleReason for Conducting This ResearchSuperior canal dehiscence syndrome (SCDS) is a rare condition in which a hole in the superior semicircular canal causes sound and pressure waves to evoke vestibular and auditory symptoms. Symptoms can include sound- or pressure-induced vertigo (Tullio phenomenon), autophony, pulsatile tinnitus, bone conduction (BC) hyperacusis, conductive hearing loss, and “brain fog” (2–5) This broad variety of symptoms can make it difficult to distinguish SCDS from other neurological and otological pathologies. The dehiscence can be approached via middle cranial fossa of the skull (“middle fossa approach”) or via the mastoid (“transmastoid approach”) Both middle fossa and transmastoid approaches allow resurfacing of the dehiscence as well as plugging of the canal and different materials have been used including fascia, bone chips, bone wax, fibrin glue and bone dust. Both approaches have shown high success rates in terms of symptom relief (5); each carries risks.
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