Underwater Endoscopic Repair of Superior Canal Dehiscence

Authors

Francis Creighton, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Samuel R. Barber, Department of Otolaryngology - Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona.
Bryan K. Ward, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jeffrey D. Sharon, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
John P. Carey, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Document Type

Article

Abstract

: Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal (SCC). Patients with SCD Syndrome (SCDS) may experience symptoms such as aural fullness, pulsatile tinnitus, hyperacusis, autophony, or pressure or noise-induced vertigo . The defect can be repaired in various ways, but there is potential for loss of perilymphatic fluid during transmastoid approaches that could result in postoperative sensorineural hearing loss . We hypothesize that if the procedure were performed "underwater" in balanced salt solution (BSS), loss of perilymphatic fluid would be minimized. CASE REPORT:: A 55-year-old male presented with right-sided autophony, pulsatile tinnitus, and hyperacusis. Audiometric testing demonstrated a low-frequency airbone gap and a supranormal bone-conduction threshold at 4 kHz. Ocular VEMP responses were increased amplitude. Temporal bone imaging revealed a SCC dehiscence.The patient was taken to the operating room for an underwater, endoscopic repair of the SCC using a transmastoid approach. A cortical mastoidectomy was performed using Landmarx image navigation. BSS filled the mastoid and a 0-degree endoscope with endoscrub was used to see the SCC underwater. The SCC was entered near the ampullated end with a bur. A stepwise plugging process included applying strips of wet and dried fascia and bone dust. The non-ampullated end was similarly plugged. BSS was suctioned, and under microscopic visualization, labyrinthotomies were capped with bone chips. The patient tolerated the procedure well and was discharged the next day. There was no sensorineural hearing loss postoperatively. CONCLUSION:: SCDS may be addressed surgically using multiple approaches. An underwater endoscopic repair of the SCC may be safe and effective surgical treatment.SDC video link: http://links.lww.com/MAO/A808.

Medical Subject Headings

Humans; Male; Mastoid; Middle Aged; Otologic Surgical Procedures; Retrospective Studies; Semicircular Canals (diagnostic imaging, surgery); Vertigo (surgery)

Publication Date

4-1-2020

Publication Title

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

E-ISSN

1537-4505

Volume

41

Issue

4

First Page

560

PubMed ID

32176150

Digital Object Identifier (DOI)

10.1097/MAO.0000000000002277

Recommended Citation

Creighton, Francis; Barber, Samuel R.; Ward, Bryan K.; Sharon, Jeffrey D.; and Carey, John P., "Underwater Endoscopic Repair of Superior Canal Dehiscence" (2020). ENT and Skull Base Surgery. 80.
https://scholar.barrowneuro.org/ent-and-skull-base-surgery/80