Superior canal dehiscence: can we predict the diagnosis?
OBJECTIVE
Identify independent clinical and audiometric factors to predict a positive high-resolution computed tomography (HRCT) scan for superior canal dehiscence (SCD).


METHODS
Retrospective chart review.


METHODS
Tertiary referral center.


METHODS
Patients presenting SCD.


METHODS
Audiogram, VEMP, temporal bone HRCT, and SCD symptoms and signs chart.


METHODS
ABG, VEMP threshold, and symptoms and signs.


RESULTS
Approximately 106 patients with SCD symptoms were included: 62 had a positive and 44 had a negative CT scan. The positive scan group showed a higher average of cochlear symptoms than the negative CT scan group (4.3 versus 2.6) (p < 0.001), but no statistical difference for vestibular symptoms (2.2 versus 1.8) was identified. CVEMP thresholds of the positive and negative CT scan groups were of 66 and 81 dB, respectively (p < 0.001). The positive CT scan group showed higher ABGs at 250 Hz (24 versus 14 dB) and 500 Hz (17 versus 8 dB) (p = 0.008 and p = 0.008, resectively). No statistical significance was found when comparing both groups for air and bone conduction thresholds. Approximately 23% of the positive CT scan group showed a Valsalva-induced vertigo against 2.3% of the negative scan group (p = 0.003); 27% of the positive CT scan group showed speculum-induced vertigo but none of the negative scan patients (p < 0.001). Using logistic regression, we found that each 10-dB unit increase in the 250 Hz ABG is associated to an increase odd of having SCD of 51% (OR, 1.51; 95% CI, 1.10-2.08).


CONCLUSIONS
Nature and number of cochlear symptoms, Valsalva and pneumatic speculum-induced vertigo, VEMP thresholds, and ABGs seem to correlate with a positive HRCT. The ABG at 250 Hz is the most accurate predictor of SCD.
From the Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), Otology and Neurotology, University of Montreal, Montreal, Quebec, Canada.
Lina Zahra
LZ
Benamira
Musaed
M
Alzahrani
Issam
I
Saliba
D000328:Adult; D000368:Aged; D001299:Audiometry; D001844:Bone Conduction / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012665:Semicircular Canals / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013701:Temporal Bone / Q000000981:diagnostic imaging; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology*; D055815:Young Adult