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Observational Study
. 2025 Jan;282(1):103-112.
doi: 10.1007/s00405-024-08896-3. Epub 2024 Aug 23.

Insights from therapeutic strategies in superior canal dehiscence syndrome: is there anything beyond surgical treatment?

Joan Lorente-Piera  1 , Carlos Prieto-Matos  2 , Nicolás Pérez Fernández  3 , Melissa Blanco-Pareja  3 , Diego Calavia Gil  2 , Manuel Manrique  2 , Raquel Manrique-Huarte  2
Affiliations
Observational Study

Insights from therapeutic strategies in superior canal dehiscence syndrome: is there anything beyond surgical treatment?

Joan Lorente-Piera et al. Eur Arch Otorhinolaryngol. 2025 Jan.

Abstract

Introduction: Superior semicircular canal dehiscence syndrome (SCDS) is a clinical syndrome that can cause instability, vertigo, fullness, tinnitus, autophony, hearing loss (HL), Tullio phenomenon, or Hennebert's sign. Historically, surgery has been the primary treatment reported in the literature, although some medical treatments may also be proposed. This study aims to comprehensively characterize SCDS in a large series of patients from clinical, auditory, and vestibular perspectives, and explore medical alternatives to conventional surgical treatments by comparing their results and evolution.

Methods: A retrospective observational study was designed in a tertiary care center. Audiovestibular tests evaluated included pure-tone audiometry (PTA), VEMPs, video head impulse test (vHIT), and CT imaging. Improvement was assessed over a follow-up period of up to 6 months for seven cardinal symptoms to verify the efficacy of the proposed treatments.

Results: 71 subjects with SCDS and a mean age of 51.20 ± 12.22 years were included in the study. The most common symptom found in our sample was instability in 31 patients (43.66%), followed by aural fullness or tinnitus in 29 subjects (40.85%). 36 patients (43.66%) received medical treatment, with 28 of them (77.78%) showing symptom reduction. Surgical repair was indicated in five patients, with all showing symptom improvement. Statistically significant improvement (p < 0.05) was observed, particularly with surgical treatment and acetazolamide, in both symptoms and objective tests such as pure-tone audiometry and VEMPs.

Conclusion: SCDS shows significant similarities with other otic capsule dehiscences. It is essential to perform VEMPs and CT scans to complete the diagnosis, which is usually accompanied by clearly recognizable clinical criteria. Surgery for SCDS is effective, safe, and without complications. However, in cases where symptoms are mild to moderate, addressing this condition with medical treatment using diuretics such as acetazolamide has shown promising results.

Keywords: CT scan; Clinical test; Differential diagnosis; Superior canal dehiscence; Third window syndrome; VEMP; Vestibular symptoms.

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Conflict of interest statement

Declarations. Institutional review board statement: This study protocol was reviewed in November 2023 and approved by Ethics committee of Clínica Universidad de Navarra, approval number (CEI 2023.163). Even more, this study was designed and performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was obtained from all to participate in the study. Even though, written informed consent was obtained from the patient for publication of the details of their medical case and any accompanying images. Informed consent: Informed consent was obtained from all subjects involved in the study. Conflict of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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