J Neurol Surg B Skull Base
DOI: 10.1055/a-2627-4027
Original Article

Tegmen Dehiscence and Audiologic Outcomes in the Middle Fossa Repair of Superior Semicircular Canal Dehiscence

1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Hong-Ho Yang
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Isaac Yang
2   Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Quinton S. Gopen
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
› Institutsangaben
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Abstract

Objective

To investigate the audiologic presentation and post-surgical audiologic outcomes of superior semicircular canal dehiscence (SSCD) with concurrent tegmen tympani dehiscence with or without dural–ossicular contact.

Methods

We reviewed 358 middle fossa repairs of SSCD at an institution from 2011 to 2022. Primary outcomes were preoperative and pre- to postoperative change in pure-tone average (PTA) and low-frequency air–bone gap (LF-ABG). Tegmen tympani dehiscence and dural–ossicular contact status were assessed on CT imaging and treated as independent variables in multivariable models.

Results

Compared with the SSCD-alone cohort, the SSCD + tegmen tympani dehiscence group had significantly higher preoperative PTA (B = 5.40; p = 0.007) and ABG at 500 Hz (B = 5.08; p = 0.007) and 1,000 Hz (B = 4.58; p = 0.003). Similar findings were seen in the SSCD + tegmen tympani dehiscence + combined dural–ossicular contact cohort for PTA (B = 5.32; p = 0.017) and ABG at 500 Hz (B = 4.50; p = 0.029) and 1,000 Hz (B = 4.66; p = 0.006). The SSCD + tegmen tympani dehiscence + unilateral dural–ossicular contact cohort had significantly higher preoperative ABG at 500 Hz (B = 5.11; p = 0.023) and 1,000 Hz (B = 5.18; p = 0.005), whereas the bilateral dural–ossicular contact group showed no significant differences. No cohort exhibited significant changes in PTA or LF-ABG postoperatively.

Conclusion

Concurrent SSCD and tegmen tympani dehiscence with or without dural–ossicular contact present with greater preoperative PTA and LF-ABG but no significantly different surgical outcomes compared with SSCD alone. Therefore, although tegmen tympani defects may contribute to greater baseline auditory deficits, the MCF approach offers similar levels of improvement in hearing across both groups.



Publikationsverlauf

Eingereicht: 18. März 2025

Angenommen: 03. Juni 2025

Accepted Manuscript online:
05. Juni 2025

Artikel online veröffentlicht:
17. Juni 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 1998; 124 (03) 249-258
  • 2 Ward BK, Carey JP, Minor LB. Superior canal dehiscence syndrome: lessons from the first 20 years. Front Neurol 2017; 8: 177
  • 3 Yew A, Zarinkhou G, Spasic M, Trang A, Gopen Q, Yang I. Characteristics and management of superior semicircular canal dehiscence. J Neurol Surg B Skull Base 2012; 73 (06) 365-370
  • 4 Zuniga MG, Janky KL, Nguyen KD, Welgampola MS, Carey JP. Ocular versus cervical VEMPs in the diagnosis of superior semicircular canal dehiscence syndrome. Otol Neurotol 2013; 34 (01) 121-126
  • 5 Sequeira SM, Whiting BR, Shimony JS, Vo KD, Hullar TE. Accuracy of computed tomography detection of superior canal dehiscence. Otol Neurotol 2011; 32 (09) 1500-1505
  • 6 Yang HH, Yang I, Gopen QS. Radiographic estimation of superior canal dehiscence area in a prediction model of surgical outcome. Otolaryngol Head Neck Surg 2025; 172 (02) 588-595
  • 7 Van Dijk SW, Peters JPM, Stokroos RJ, Thomeer HGXM. Surgical decision-making in superior canal dehiscence syndrome with concomitant otosclerosis. Eur Arch Otorhinolaryngol 2024; 281 (07) 3859-3865
  • 8 Rodgers B, Lin J, Staecker H. Transmastoid resurfacing versus middle fossa plugging for repair of superior canal dehiscence: comparison of techniques from a retrospective cohort. World J Otorhinolaryngol Head Neck Surg 2016; 2 (03) 161-167
  • 9 Phillips DJ, Souter MA, Vitkovic J, Briggs RJ. Diagnosis and outcomes of middle cranial fossa repair for patients with superior semicircular canal dehiscence syndrome. J Clin Neurosci 2010; 17 (03) 339-341
  • 10 Trieu V, Pelargos PE, Spasic M. et al. Minimally invasive middle fossa keyhole craniectomy for repair of superior semicircular canal dehiscence. Oper Neurosurg (Hagerstown) 2017; 13 (03) 317-323
  • 11 Seiwerth I, Dlugaiczyk J, Schmäl F, Rahne T, Kösling S, Plontke SK. Superior semicircular canal dehiscence isolation by transmastoid two-point canal plugging with preservation of the vestibulo-ocular reflex. HNO 2024; . Epub ahead of print.
  • 12 Crovetto M, Areitio E, Elexpuru J, Aguayo F. Transmastoid approach for resurfacing of superior semicircular canal dehiscence. Auris Nasus Larynx 2008; 35 (02) 247-249
  • 13 Suryanarayanan R, Lesser TH. “Honeycomb” tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence. J Laryngol Rhinol Otol 2010; 124 (05) 560-563
  • 14 Nadaraja GS, Gurgel RK, Fischbein NJ. et al. Radiographic evaluation of the tegmen in patients with superior semicircular canal dehiscence. Otol Neurotol 2012; 33 (07) 1245-1250
  • 15 Crovetto M, Whyte J, Rodriguez OM, Lecumberri I, Martinez C, Eléxpuru J. Anatomo-radiological study of the superior semicircular canal dehiscence radiological considerations of superior and posterior semicircular canals. Eur J Radiol 2010; 76 (02) 167-172
  • 16 Wentland C, Cousins J, May J, Rivera A. Dural contact to the malleus head in patients with superior semicircular canal dehiscence (SSCD): case series and review of SSCD and tegmen defects. Ann Otol Rhinol Laryngol 2021; 130 (12) 1400-1406
  • 17 Formeister EJ, Zhang L, Dent J, Aygun N, Carey JP. Predictive factors for concurrent tegmen dehiscence in superior canal dehiscence syndrome. Otol Neurotol 2022; 43 (04) 494-499
  • 18 Noij KS, Rauch SD. Vestibular evoked myogenic potential (VEMP) testing for diagnosis of superior semicircular canal dehiscence. Front Neurol 2020; 11: 695
  • 19 Ward BK, van de Berg R, van Rompaey V. et al. Superior semicircular canal dehiscence syndrome: diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the Bárány Society. J Vestib Res 2021; 31 (03) 131-141
  • 20 Gurgel RK, Jackler RK, Dobie RA, Popelka GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012; 147 (05) 803-807
  • 21 Johanis M, Yang I, Gopen Q. Incidence of intraoperative hearing loss during middle cranial fossa approach for repair of superior semicircular canal dehiscence. J Clin Neurosci 2018; 54: 109-112
  • 22 Yang HH, Yang I, Gopen QS. Audiometric outcomes after the middle cranial fossa repair of superior semicircular canal dehiscence. Otol Neurotol 2023; 44 (06) 593-599
  • 23 Auerbach BD, Gritton HJ. Hearing in complex environments: auditory gain control, attention, and hearing loss. Front Neurosci 2022; 16: 799787
  • 24 Irvine DRF. Plasticity in the auditory system. Hear Res 2018; 362: 61-73
  • 25 Willmore BDB, King AJ. Adaptation in auditory processing. Physiol Rev 2023; 103 (02) 1025-1058