title: Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal.
abstract: OBJECTIVE
  To present symptoms, patterns of nystagmus, and computed tomographic scan identification of patients with sound- and/or pressure-induced vertigo due to dehiscence of bone overlying the superior semicircular canal. To describe anatomical findings and outcome in 2 patients undergoing plugging of the superior semicircular canal for treatment of these symptoms.
  
  
  METHODS
  Prospective study of a case series in a tertiary care referral center.
  
  
  RESULTS
  Eight patients with vertigo, oscillopsia, and/or disequilibrium related to sound, changes in middle ear pressure, and/or changes in intracranial pressure were identified in a 2-year period. Seven of these patients also had vertical-torsional eye movements induced by these sound and/or pressure stimuli. The direction of the evoked eye movements could be explained by excitation or inhibition of the superior semicircular canal in the affected ear. Computed tomographic scans of the temporal bones identified dehiscence of bone overlying the affected superior semicircular canal in each case. Disabling disequilibrium in 2 patients prompted plugging of the dehiscent superior canal through a middle cranial fossa approach. Symptoms were improved in each case. One patient developed recurrent symptoms requiring an additional plugging procedure and developed sensorineural hearing loss several days after this second procedure.
  
  
  CONCLUSIONS
  We have identified patients with a syndrome of vestibular symptoms induced by sound in an ear or by changes in middle ear or intracranial pressure. These patients can also experience chronic disequilibrium. Eye movements in the plane parallel to that of the superior semicircular canal were evoked by stimuli that have the potential to cause ampullofugal or ampullopetal deflection of this canal's cupula in the presence of a dehiscence of bone overlying the canal. The existence of such deshiscences was confirmed with computed tomographic scans of the temporal bones. Surgical plugging of the affected canal may be beneficial in patients with disabling symptoms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21203-6402, USA. lminor@welchlink.welch.jhu.edu
authors.forename: L B
authors.initials: LB
authors.lastname: Minor
authors.forename: D
authors.initials: D
authors.lastname: Solomon
authors.forename: J S
authors.initials: JS
authors.lastname: Zinreich
authors.forename: D S
authors.initials: DS
authors.lastname: Zee
mesh_terms: D000328:Adult; D004432:Ear, Middle / Q000503:physiopathology; D005133:Eye Movements; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000503:physiopathology; D011312:Pressure; D012008:Recurrence; D012665:Semicircular Canals / Q000000981:diagnostic imaging / Q000473:pathology*; D013016:Sound; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014717:Vertigo / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology