Herbert Silverstein1, Jack M Kartush2, Lorne S Parnes3, Dennis S Poe4, Seilesh C Babu2, Mark J Levenson5, Jack Wazen6, Ryan W Ridley6. 1. Silverstein Institute, Ear Research Foundation, Sarasota, FL. Electronic address: hsilverste@aol.com. 2. Michigan Ear Institute, Farmington Hills, MI. 3. London Health Sciences Centre, London, Ontario. 4. Boston Children's Hospital, Boston, MA. 5. Saratoga Ear and Sinus Surgery, Saratoga Springs, NY. 6. Silverstein Institute, Ear Research Foundation, Sarasota, FL.
Abstract
PURPOSE: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity. RESULTS: Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery. CONCLUSION: RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.
PURPOSE: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity. RESULTS: Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery. CONCLUSION: RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.
Authors: P Ashley Wackym; Heather T Mackay-Promitas; Shaban Demirel; Gerard J Gianoli; Martin S Gizzi; Dale M Carter; David A Siker Journal: Laryngoscope Investig Otolaryngol Date: 2017-08-22
Authors: Mira E Ossen; Robert Stokroos; Herman Kingma; Joost van Tongeren; Vincent Van Rompaey; Yasin Temel; Raymond van de Berg Journal: Front Neurol Date: 2017-07-24 Impact factor: 4.003