title: Long-term results of middle fossa plugging of superior semicircular canal dehiscences: clinically and instrumentally demonstrated efficiency in a retrospective series of 16 ears.
abstract: The objective of this study is to report the surgical outcome after middle fossa approach (MFA) plugging in patients suffering from a superior semi-circular canal dehiscence (SCD) syndrome. This is a retrospective case review. Tertiary referral center. Sixteen ears in 13 patients with a SCD syndrome suffering from severe and disabling vestibular symptoms with a bony dehiscence on CT scan >3 mm and decreased threshold of cervical vestibular evoked potentials (cVEMPs). We assessed preoperatively: clinical symptoms, hearing, cVEMPs threshold, size of dehiscence and videonystagmography (VNG) with caloric and 100 Hz vibratory tests. Postoperatively, we noted occurrences of neurosurgical complication, evolution of audiological and vestibular symptoms, and evaluation of cVEMP data. Tullio's phenomenon was observed in 13 cases (81.3 %) and subjectively reported hearing loss in seven (43.7 %). All patients were so disabled that they had to stop working. No neurosurgical complications were observed in the postoperative course. In three cases (16.6 %), an ipsilateral and transitory immediate postoperative vestibular deficit associated with a sensorineural hearing loss (SNHL) was noted, which totally resolved with steroids and bed rest. All patients were relieved of audiological and vestibular symptoms and could return to normal activity with a mean follow-up of 31.1 months (range 3-95). No patient had residual SNHL. cVEMPs were performed in 14 ears postoperatively and were normalized in 12 (85.7 %). Two of the three patients operated on both sides kept some degree of unsteadiness and oscillopsia. MFA plugging of the superior semi-circular canal is an efficient and non-hearing deteriorating procedure.
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France. h.g.x.m.thomeer@umcutrecht.nl.|Department of Otorhinolaryngology, University Medical Center Utrecht, 85500, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. h.g.x.m.thomeer@umcutrecht.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Thomeer
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnard
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Castetbon
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Franco-Vidal
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Darrouzet
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux Segalen University, 33000, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Darrouzet
mesh_terms: D000328:Adult; D001299:Audiometry / Q000379:methods; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000175:diagnosis / Q000209:etiology; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D012665:Semicircular Canals / Q000473:pathology / Q000601:surgery; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015837:Vestibular Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014724:Vestibular Function Tests / Q000379:methods; D014722:Vestibule, Labyrinth / Q000473:pathology / Q000601:surgery
keywords: Dehiscence; Hearing impairment; Middle fossa; SCDS; Semicircular canal; Surgery; Tinnitus; Vertigo