Outpatient repair of superior semicircular canal dehiscence via the transmastoid approach

Abstract

Objectives/hypothesis: Superior semicircular canal dehiscence (SSCD) syndrome has been a topic of much interest since its first description a decade ago. The symptoms of vertigo, autophony, and Tullio phenomenon have been well described as has the utility of surgical repair. The standard approach described for surgical repair of this problem has been to perform a middle fossa craniotomy followed by plugging of the superior semicircular canal. Recently, a transmastoid approach has been described as another surgical option in cases of SSCD, an alternative that could avoid the known risks of a middle fossa craniotomy. Herein we present further data for validation of the transmastoid SSCD repair technique. Additional factors leading to the successful treatment of these patients in the outpatient setting, an approach not previously described, are detailed.

Study design: Retrospective study of three separate operative procedures in two patients (one patient with bilateral SSCD) in an academic medical center is presented along with postoperative course and hearing status.

Methods: Three ears with radiographic evidence of SSCD confirmed with vestibular evoked myogenic potentials after symptomatic presentation were studied. Each ear had preoperative and postoperative audiometry and outpatient surgery. SSCD was repaired in each patient using a transmastoid approach with specific anesthetic and surgical precautions taken to minimize nausea and vertigo.

Results: Each patient was discharged from the outpatient unit with two cases returning home the day of surgery and one case after 23-hour observation. All had resolution of their SSCD symptoms and postoperative hearing testing revealed no evidence of sensorineural hearing loss and resolution of related conductive components.

Conclusions: The advantages noted by others with regards to the transmastoid repair of SSCD related symptomatology appear genuine and reproducible. In addition, this approach appears to offer potential freedom from a prolonged hospital admission with the potential for outpatient surgery in some circumstances without compromised clinical outcomes.