Abstract
BackgroundSuperior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis.MethodsA retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with Pöschl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans.ResultsOf the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the Pöschl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < −2.5 in the axial spine, while another had osteopenia with a T-score of −2.3 in the left femur.ConclusionsWe describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.
Highlights
Superior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon or Hennebert sign due to the absence of bone overlying the SSC
The initial population described by Minor et al [1] in 1998 was young, with a median age of 41, and they experienced vertigo or oscillopsia inducible by sound (Tullio phenomenon) and/or increased middle ear or intracranial pressure (Hennebert sign)
Dizziness, or disequilibrium with unclear etiology, as well as those suspected of having unusual inner ear pathology, underwent high-resolution multi-detector Computed tomography (CT) of the temporal bone, with 0.625 mm slices and reformations of the SSC along the longitudinal axis (Pöschl view) and transverse axis (Stenvers view)
Summary
Superior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis. Superior semicircular canal dehiscence (SSCD) is an uncommon cause of vertigo and disequilibrium. The initial population described by Minor et al [1] in 1998 was young, with a median age of 41, and they experienced vertigo or oscillopsia inducible by sound (Tullio phenomenon) and/or increased middle ear or intracranial pressure (Hennebert sign). Our patients were all elderly women of East Asian descent, had concomitant osteoporosis or osteopenia, and lacked Tullio phenomenon or Hennebert sign
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