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Otology/Neurotology

Symptom Unmasking Following Unilateral Surgery for Bilateral Superior Canal Dehiscence

Monday, October 2, 2023
4:39 PM - 4:45 PM East Coast USA Time
Location: 104BC

    Presenting Author(s)

  • KS

    Krish Suresh, MD

    Resident Physician
    Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, MA, United States

    • Co-Author(s)

  • AG

    Alejandro Garcia, MD

    Resident
    University of Iowa
    Boston, MA, United States

  • ON

    Obinna Nwosu, MD

    Massachusetts Eye and Ear, USA

  • Ryan A. Bartholomew, MD

    Resident
    Brigham & Women's Hospital/Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, Massachusetts, United States

  • YS

    Yohan Song, MD

    Massachusetts Eye and Ear, USA

    • Senior Author(s)

  • Daniel J. Lee, MD

    Associate Professor, HMS
    Massachusetts Eye and Ear Infirmary (MEEI)
    Boston, MA, United States

Disclosure(s):
Krish Suresh, MD: No relevant relationships to disclose.
Introduction: Approximately 30% of patients with superior canal dehiscence syndrome (SCDS) have bilateral defects on computed tomography (CT). This has implications for patient counseling, as unilateral surgery may result in “unmasking” of symptoms from the previously asymptomatic or mildly affected contralateral ear. In this study, we compare auditory and vestibular symptoms for patients with unilateral vs bilateral dehiscence who underwent unilateral surgical repair.

Methods: Retrospective review of SCD patients who underwent surgery from 2002-2021. 6 patients with bilateral dehiscence underwent bilateral sequential surgery; for these subjects, data from only the initial unilateral surgery was included. We recorded the presence or absence of 16 symptoms (11 auditory and 8 vestibular) pre- and post-operatively. Symptom rates were compared between patients with unilateral and bilateral dehiscence.

Results: Our final study cohort included 125 patients, 93 (74%) with unilateral SCDS and 32 (26%) with bilateral SCDS. Bilateral patients had a greater number of auditory and vestibular symptoms compared to unilateral patients before surgery (7.6 vs 6.2, p = 0.03*) and after surgery (3.1 vs 1.9, p = 0.02*). Both groups experienced a significant reduction of symptoms following repair (p < 0.01* for both). Analyzing symptoms individually, almost all symptoms were more prevalent among bilateral patients, with the following reaching statistical significance: preoperative aural fullness (69% vs 40%, p = 0.01*), postoperative autophony (25% vs 5%, p = 0.01*), and postoperative pulsatile tinnitus (28% vs 9%, p = 0.01*).

Conclusions: SCDS patients with bilateral dehiscence have greater rates of auditory and vestibular symptoms, both before and after repair. While surgery is still an effective option in this cohort, bilateral SCDS patients should be counseled that they are at increased risk of persistent symptoms following surgery and may have prolonged recovery.