title: Common features in patients with superior canal dehiscence declining surgical treatment.
abstract: BACKGROUND
  Superior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients' tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients' choice of a surgical management over watchful waiting.
  
  
  METHODS
  Sixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting.
  
  
  RESULTS
  Of these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421).
  
  
  CONCLUSIONS
  The natures of cochleovestibular signs and symptoms were shown to be key factors in patients' choice of a surgical management whereas paraclinical tests seem to be less significant in the patients' decision for a surgical treatment.
authors.affiliation: Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Lina Zahra
authors.initials: LZ
authors.lastname: Benamira
authors.affiliation: Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Maniakas
authors.affiliation: Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Musaed
authors.initials: M
authors.lastname: Alzahrani
authors.affiliation: Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Issam
authors.initials: I
authors.lastname: Saliba
keywords: Autophony; Dehiscence syndrome; Hyperacousis; Occulophony; Superior canal