Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker.
OBJECTIVE
To identify otologic and audiologic characteristics of superior (and posterior) semicircular canal dehiscence (SCD).


METHODS
Retrospective case review.


METHODS
Tertiary referral center.


METHODS
Sixty-five adult patients were evaluated for SCD; 26 of 65 (35 ears) had dehiscence.


METHODS
Otologic examination, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and vestibular evoked myogenic potential (VEMP).


METHODS
Imaging demonstrating canal dehiscence, preferentially including Poschel and Stenvers reconstructions. Audiologic findings of pseudoconductive loss, intact ipsilateral stapedial reflex, and abnormally low VEMP thresholds.


RESULTS
The most common presenting complaints were autophony of voice and a "blocked ear" (94%), mimicking patulous eustachian tube, including relief with Valsalva or supine position (50%), but without autophony of nasal breathing. Pseudoconductive loss was found in 86% of dehiscence ears, and 60% (21 of 35) of these ears had better than 0-dB-hearing-loss bone conduction thresholds at 250 and/or 500 Hz. Acoustic reflex was present in 89%. Assuming CT as the criterion standard, VEMP resulted in 91.4% sensitivity and 95.8% specificity. One false-positive CT, with abnormal VEMP, resulted in surgical explorations negative for superior SCD but positive for posterior SCD.


CONCLUSIONS
Semicircular canal dehiscence may present with various symptoms such as autophony, ear blockage, and dizziness/vertigo. A combination of high-resolution CT and audiologic testing is recommended for diagnosis. Low-frequency conductive loss with better than 0 dB hearing level (HL) bone conduction threshold and normal tympanometry, with intact acoustic reflexes, are audiologic signs of SCD. Vestibular evoked myogenic potential is highly sensitive and specific for SCD, possibly better than CT.
Zhou
Guangwei
G
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, MA 02115, USA. guangwei.zhou@childrens.harvard.edu
Gopen
Quinton
Q
Poe
Dennis S
DS
D000158:Acoustic Impedance Tests; D000328:Adult; D000368:Aged; D000375:Aging; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction / Q000502:physiology; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D004244:Dizziness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D004427:Ear Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D007759:Labyrinth Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012022:Reflex, Acoustic / Q000502:physiology; D012189:Retrospective Studies; D012665:Semicircular Canals; D016683:Supine Position; D014057:Tomography, X-Ray Computed; D014636:Valsalva Maneuver; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014724:Vestibular Function Tests