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Fredén Jansson KJ, Håkansson B, Persson AC, Verrecchia L, Reinfeldt S. Electroacoustic evaluation of the bone conduction transducer B250 for vestibular and hearing diagnostics in comparison with Radioear B71 and B81. Int J Audiol 2024:1-7. [PMID: 38742487 DOI: 10.1080/14992027.2024.2352054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The objective is to evaluate the electroacoustic performance of the B250 transducer and to compare it with the two most widely used audiometric transducers B71 and B81. DESIGN The electroacoustic performance was evaluated in terms of sensitivity level, distortion, maximum hearing level and electrical impedance. STUDY SAMPLE Six B250 prototype transducers were evaluated and compared with published data of B71 and B81 together with complementary measurements of maximum hearing level at 125 Hz and phase of electrical impedance. Differences in reference equivalent threshold vibratory force levels were estimated by comparing hearing threshold measurements of 60 healthy ears using B81 and B250. RESULTS B250 has approximately 27 dB higher sensitivity levels than both B71 and B81 at 250 Hz and can generate higher maximum hearing level at low frequencies: 11.8 to 35.8 dB (125-1000 Hz) higher than B71, and 1.4 to 18.6 dB (125-750 Hz) higher than B81. The maximum average difference in reference threshold force levels was 13.5 ± 8.7 dB higher for B250 at 250 Hz compared to B81. CONCLUSIONS B250 can produce higher output force with less distortion than B71 and B81, especially at 125 and 250 Hz, which could possibly improve low frequency investigations of the audio-vestibular system.
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Affiliation(s)
| | - Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Ann-Charlotte Persson
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Habilitation & Health, Hearing Organization, Gothenburg, Sweden
| | - Luca Verrecchia
- ENT Unit, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Reinfeldt
- Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
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2
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Michailidou E, Rüegg PO, Karrer T, Korda A, Weder S, Kompis M, Caversaccio M, Mantokoudis G. Hearing Results after Transmastoid Superior Semicircular Canal Plugging for Superior Semicircular Canal Dehiscence: A Meta-Analysis. Audiol Res 2023; 13:730-740. [PMID: 37887846 PMCID: PMC10604912 DOI: 10.3390/audiolres13050065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.gov. A systematic literature review and meta-analysis of the pooled data were conducted. We also included a consecutive case series with SCDS for those who underwent transmastoid plugging treatment at our clinic. RESULTS We identified 643 citations and examined 358 full abstracts and 88 full manuscripts. A total of 16 studies were eligible for the systematic review and 11 studies for the meta-analysis. Furthermore, 159 ears (152 patients) were included. The postoperative mean air conduction threshold remained unchanged (mean difference, 2.89 dB; 95% CI: -0.05, 5.84 dB, p = 0.58), while the mean bone conduction threshold was significantly worse (mean difference, -3.53 dB; 95% CI, -6.1, -0.95 dB, p = 0.9). CONCLUSION The transmastoid plugging technique for superior semicircular canal dehiscence syndrome, although minimally worsening the inner ear threshold, is a safe procedure in terms of hearing preservation and satisfactory symptom relief.
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Affiliation(s)
- Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Pascal Oliver Rüegg
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Tanya Karrer
- Medical Library, University Library of Bern, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
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Curthoys IS, Smith CM, Burgess AM, Dlugaiczyk J. A Review of Neural Data and Modelling to Explain How a Semicircular Canal Dehiscence (SCD) Causes Enhanced VEMPs, Skull Vibration Induced Nystagmus (SVIN), and the Tullio Phenomenon. Audiol Res 2023; 13:418-430. [PMID: 37366683 DOI: 10.3390/audiolres13030037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Angular acceleration stimulation of a semicircular canal causes an increased firing rate in primary canal afferent neurons that result in nystagmus in healthy adult animals. However, increased firing rate in canal afferent neurons can also be caused by sound or vibration in patients after a semicircular canal dehiscence, and so these unusual stimuli will also cause nystagmus. The recent data and model by Iversen and Rabbitt show that sound or vibration may increase firing rate either by neural activation locked to the individual cycles of the stimulus or by slow changes in firing rate due to fluid pumping ("acoustic streaming"), which causes cupula deflection. Both mechanisms will act to increase the primary afferent firing rate and so trigger nystagmus. The primary afferent data in guinea pigs indicate that in some situations, these two mechanisms may oppose each other. This review has shown how these three clinical phenomena-skull vibration-induced nystagmus, enhanced vestibular evoked myogenic potentials, and the Tullio phenomenon-have a common tie: they are caused by the new response of semicircular canal afferent neurons to sound and vibration after a semicircular canal dehiscence.
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Affiliation(s)
- Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher M Smith
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building, Room 12-90, 1468 Madison Ave., New York, NY 10029, USA
| | - Ann M Burgess
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery & Interdisciplinary Center of Vertigo, Balance and Ocular Motor Disorders, University Hospital Zurich (USZ), University of Zurich (UZH), CH-8091 Zürich, Switzerland
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4
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Bhatt AA, Lundy LB, Rhyner PA. Supralabyrinthine air cell is not present in superior semicircular canal dehiscence. J Clin Imaging Sci 2022; 12:50. [PMID: 36128349 PMCID: PMC9479531 DOI: 10.25259/jcis_73_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Superior semicircular canal dehiscence (SSCD) is defined as a defect in the bone overly the superior semicircular canal (SSC). The purpose of this study is to evaluate the pre-operative imaging examinations of patients who have undergone SSCD repair. We hypothesize that these patients will not have a supralabyrinthine air cell on the side of surgery. Material and Methods: Our group retrospectively reviewed 50 consecutive pre-operative computed tomography (CT) temporal bone examinations who had confirmed SSCD on intraoperative examination and underwent repair for the presence of a supralabyrinthine air cell. Results: 100% of patients who had confirmed SSCD on intraoperative examination had no supralabyrinthine air cell on pre-operative CT of the temporal bone. Conclusion: This study shows that a supralabyrinthine air cell is not present in SSCD. When a supralabyrinthine air cell is present, the roof of the SSC is intact. CT and magnetic resonance imaging (MRI) are often performed together to evaluate for SSCD and exclude other etiologies. We propose that if a supralabyrinthine air cell is seen on MRI, no CT is necessary, thus avoiding unnecessary radiation exposure and additional imaging costs to the patient.
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Affiliation(s)
- Alok A. Bhatt
- Department of Radiology, Mayo Clinic, Jacksonville, United States,
| | - Larry B. Lundy
- Department of Otolaryngology, Mayo Clinic, Jacksonville, United States,
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McCrary HC, Babajanian E, Patel N, Yang S, Kircher M, Carlson ML, Gurgel RK. Superior Semicircular Canal Dehiscence Syndrome Following Head Trauma: A Multi-institutional Review. Laryngoscope 2021; 131:E2810-E2818. [PMID: 34272884 DOI: 10.1002/lary.29751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate patients who become symptomatic from superior semicircular canal dehiscence (SSCD) following head trauma. STUDY DESIGN Case series assessing patients presenting with SSCD after a trauma. METHODS A case series was completed assessing patients presenting with SSCD after trauma. Data from three academic medical centers were evaluated, including the following: imaging, videonystagmography (VNG)/vestibular evoked myogenic potential (VEMP) testing, audiometric assessment, and surgical repair. Outcome measures included the following: 1) Description of audio-vestibular symptoms, 2) mean pre- and post-operative pure tone average (PTA), word recognition score (WRS), and air bone gap (ABG). RESULTS A total of 14 patients were included; 86% were male. Approximately 43% were found to have bilateral SSCD on imaging, with 57% of patients pursuing surgical management. The most common presenting symptoms included pulsatile tinnitus (93%), autophony (79%), and hearing loss (64%). Approximately 36% of patients underwent VNG/VEMP testing, with 83.3% of those demonstrating abnormal results. The mean audiometric findings on the symptomatic side included an air-conduction PTA of 38.0 dB, bone-conduction PTA of 24.3 dB, WRS of 81%, and ABG of 17.9 dB. Among patients who underwent surgery (57%), there was no significant change in the air-conduction PTA, bone-conduction PTA, or WRS (P > .05). However, there was an improvement in the ABG (preoperative = 22.8 dB versus postoperative = 9.7 dB; P = .005). CONCLUSION Head trauma may be a potentiating event for SSCD syndrome. This study advances the hypothesis that these patients likely have underlying radiographic SSCD prior to their trauma, and a traumatic event increases in intra-vestibular or intracranial pressures, unmasking SSCD syndrome. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2810-E2818, 2021.
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Affiliation(s)
- Hilary C McCrary
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Eric Babajanian
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Neil Patel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Sara Yang
- Department of Otolaryngology-Head and Neck Surgery, Loyola University, Chicago, Illinois, U.S.A
| | - Matthew Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University, Chicago, Illinois, U.S.A
| | - Matthew L Carlson
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Totten DJ, Smetak MR, Manzoor NF, Perkins EL, Cass ND, Hatton K, Santapuram P, O'Malley MR, Haynes DS, Bennett ML, Rivas A. Endoscope-Assisted Superior Semicircular Canal Dehiscence Repair: Single Institution Outcomes. Ann Otol Rhinol Laryngol 2021; 131:743-748. [PMID: 34459286 DOI: 10.1177/00034894211041223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare outcomes of endoscope-assisted middle cranial fossa MCF) repair of superior semicircular canal dehiscence (SSCD) compared to microscopic MCF repair. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center neurotology practice. METHODS Retrospective chart review and cohort study of patients who underwent surgical repair of SSCD via MCF approach from 2010 to 2019 at our institution. Patients were categorized according to use of endoscope intraoperatively. Pre- and post-operative symptom number was calculated from 8 patient-reported symptoms. Pre- and post-operative changes in symptom number were assessed using paired t-tests. Single-predictor binary logistic regression was used to compare final reported symptoms between cohorts. Linear regression was performed to assess air-bone gap (ABG) changes postoperatively between cohorts. RESULTS Forty-six patients received surgical management for SSCD. Of these, 27 (59%) were male and 19 (41%) were female. Bilateral SSCD was present in 14 cases (29%), of which 3 underwent surgical management bilaterally, for a total of 49 surgical ears. Surgery was performed on the right ear in 19 cases (39%) and on the left in 30 cases (61%). Forty ears (82%) underwent microscopic repair while 9 (18%) underwent endoscope-assisted repair. Microscopic and endoscope-assisted MCF repair both demonstrated significantly improved symptom number postoperatively (P < .001 for each). There was no significant difference in change in ABG between the 2 cohorts. On average, patient-reported symptoms and audiometrically-tested hearing improved postoperatively in both groups. CONCLUSION While endoscopic-assisted MCF repair has the potential to provide better visualization of medial and downslope defects, repair via this technique yields similar results and is equivalent to MCF repair utilizing the microscope alone.
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Affiliation(s)
| | | | | | | | - Nathan D Cass
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey Hatton
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - David S Haynes
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marc L Bennett
- Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Bhatt AA, Lundy LB, Middlebrooks EH, Vibhute P, Gupta V, Rhyner PA. Superior Semicircular Canal Dehiscence : Covering Defects in Understanding from Clinical to Radiologic Evaluation. Clin Neuroradiol 2021; 31:933-941. [PMID: 34097081 DOI: 10.1007/s00062-021-01037-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Superior semicircular canal dehiscence alters the normal fluid mechanics of the vestibulocochlear system and can be a debilitating condition. This article reviews the current understanding of the bony labyrinthine defect, including symptoms, etiology, surgical approach, as well as preoperative and postoperative imaging pearls.
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Affiliation(s)
- Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA.
| | - Larry B Lundy
- Department of Otolaryngology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Patricia A Rhyner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
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8
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Eberhard KE, Chari DA, Nakajima HH, Klokker M, Cayé-Thomasen P, Lee DJ. Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome. Front Neurol 2021; 12:638574. [PMID: 33889125 PMCID: PMC8055857 DOI: 10.3389/fneur.2021.638574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Divya A. Chari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Hideko Heidi Nakajima
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Mads Klokker
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
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9
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Guan X, Cheng YS, Galaiya DJ, Rosowski JJ, Lee DJ, Nakajima HH. Bone-conduction hyperacusis induced by superior canal dehiscence in human: the underlying mechanism. Sci Rep 2020; 10:16564. [PMID: 33024221 PMCID: PMC7538896 DOI: 10.1038/s41598-020-73565-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
Abstract
Our ability to hear through bone conduction (BC) has long been recognized, but the underlying mechanism is poorly understood. Why certain perturbations affect BC hearing is also unclear. An example is BC hyperacusis (hypersensitive BC hearing)—an unnerving symptom experienced by patients with superior canal dehiscence (SCD). We measured BC-evoked sound pressures in scala vestibuli (PSV) and scala tympani (PST) at the basal cochlea in cadaveric human ears, and estimated hearing by the cochlear input drive (PDIFF = PSV – PST) before and after creating an SCD. Consistent with clinical audiograms, SCD increased BC-driven PDIFF below 1 kHz. However, SCD affected the individual scalae pressures in unexpected ways: SCD increased PSV below 1 kHz, but had little effect on PST. These new findings are inconsistent with the inner-ear compression mechanism that some have used to explain BC hyperacusis. We developed a computational BC model based on the inner-ear fluid-inertia mechanism, and the simulated effects of SCD were similar to the experimental findings. This experimental-modeling study suggests that (1) inner-ear fluid inertia is an important mechanism for BC hearing, and (2) SCD facilitates the flow of sound volume velocity through the cochlear partition at low frequencies, resulting in BC hyperacusis.
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Affiliation(s)
- Xiying Guan
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA. .,Massachusetts Eye and Ear, Boston, MA, USA.
| | - Y Song Cheng
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, Boston, MA, USA.,New York University Medical Center, New York, NY, USA
| | - Deepa J Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, Boston, MA, USA.,Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John J Rosowski
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, Boston, MA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, Boston, MA, USA
| | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, Boston, MA, USA
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Evidence of a Vestibular Origin for Crossed-Sternocleidomastoid Muscle Responses to Air-Conducted Sound. Ear Hear 2019; 41:896-906. [PMID: 31688318 DOI: 10.1097/aud.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Small, excitatory surface potentials can sometimes be recorded from the contralateral sternocleidomastoid muscle (SCM) following monaural acoustic stimulation. Little is known about the physiological properties of these crossed reflexes. In this study, we sought the properties of crossed SCM responses and through comparison with other cochlear and vestibular myogenic potentials, their likely receptor origin. DESIGN Surface potentials were recorded from the ipsilateral and contralateral SCM and postauricular (PAM) muscles of 11 healthy volunteers, 4 patients with superior canal dehiscence and 1 with profound hearing loss. Air-conducted clicks of 105 dB nHL and tone bursts (250 to 4000 Hz) of 100 dB nHL were presented monaurally through TDH 49 headphones during head elevation. Click-evoked responses were recorded under two conditions of gaze in random order: gaze straight ahead and rotated hard toward the contralateral recording electrodes. Amplitudes (corrected and uncorrected) and latencies for crossed SCM responses were compared with vestibular (ipsilateral SCM) and cochlear (PAM) responses between groups and across the different recording conditions. RESULTS Surface waveforms were biphasic; positive-negative for the ipsilateral SCM, and negative-positive for the contralateral SCM and PAM. There were significant differences in the amplitudes and latencies (p = 0.004) for click responses of healthy controls across recording sites. PAM responses had the largest mean-corrected amplitudes (2.3 ± 2.8) and longest latencies (13.0 ± 1.2 msec), compared with ipsilateral (1.6 ± 0.5; 12.0 ± 0.7 msec) and contralateral (0.8 ± 0.3; 10.4 ± 1.0 msec) SCM responses. Uncorrected amplitudes and muscle activation for PAM increased by 104.4% and 46.8% with lateral gaze respectively, whereas SCM responses were not significantly affected. Click responses of patients with superior canal dehiscence followed a similar latency, amplitude, and gaze modulation trend as controls. SCM responses were preserved in the patient with profound hearing loss, yet all PAM were absent. There were significant differences in the frequency tuning of the three reflexes (p < 0.001). Tuning curves of healthy controls were flat for PAM and down sloping for ipsilateral and contralateral SCM responses. For superior canal dehiscence, they were rising for PAM and slightly down sloping for SCM responses. CONCLUSIONS Properties of crossed SCM responses were similar, though not identical, to those of ipsilateral SCM responses and are likely to be predominantly vestibular in origin. They are unlikely to represent volume conduction from the PAM as they were unaffected by lateral gaze, were shorter in latency, and had different tuning properties. The influence of crossed vestibulo-collic pathways should be considered when interpreting cervical vestibular-evoked myogenic potentials recorded under conditions of binaural stimulation.
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11
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Papathanasiou E, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review. Clin Neurophysiol 2019; 130:1539-1556. [DOI: 10.1016/j.clinph.2019.04.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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12
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Pienkowski M. Rationale and Efficacy of Sound Therapies for Tinnitus and Hyperacusis. Neuroscience 2019; 407:120-134. [DOI: 10.1016/j.neuroscience.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022]
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13
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Re M, Gioacchini FM, Salvolini U, Totaro AM, Santarelli A, Mallardi V, Magliulo G. Multislice Computed Tomography Overestimates Superior Semicircular Canal Dehiscence Syndrome. Ann Otol Rhinol Laryngol 2019. [DOI: 10.1177/000348941312201005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Massimo Re
- Department of Otorhinolaryngology, Marche Polytechnic University, Ancona
| | | | - Ugo Salvolini
- Department of Neuroradiology, Marche Polytechnic University, Ancona
| | | | | | - Vito Mallardi
- Department of Otorhinolaryngology, Marche Polytechnic University, Ancona
| | - Giuseppe Magliulo
- G. Ferreri Department of Otorhinolaryngology, La Sapienza University, Rome, Italy
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14
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Seroussi J, Hautefort C, Gillibert A, Kania R, Guichard JP, Vitaux H, Herman P, Houdart E, Attyé A, Eliezer M. Postoperative MR imaging features after superior semicircular canal plugging in Minor syndrome. Diagn Interv Imaging 2018; 99:679-687. [PMID: 30220585 DOI: 10.1016/j.diii.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/03/2018] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the postoperative magnetic resonance imaging (MRI) features after superior semicircular canal plugging in patients with Minor syndrome. MATERIALS AND METHODS The MRI examinations with 3D T2-weighted SPACE sequence of 12 patients with superior semicircular canal dehiscence syndrome (SCDS) were retrospectively assessed. Two radiologists independently evaluated the presence of a filling defect of the superior semicircular canal above the superior ampulla and the common crus using an oblique plane parallel to the superior semicircular canal (Pöschl's plane). RESULTS Postoperative MRI showed a filling defect above the ampulla of the superior semicircular canal and the common crus in 8/12 patients (67%). Three patients (3/12; 25%) had a filling defect involving also the superior ampulla that caused postoperative labyrinthitis with labyrinthine enhancement on MRI in 2 patients. One patient (1/12; 8%) had incomplete plugging of superior semicircular canal with abnormal functional tests and remaining symptoms. CONCLUSION Postoperative MRI shows a normal plugging aspect of the superior semicircular canal in 67% of patients. MRI can reveal complications that may have therapeutic implications.
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Affiliation(s)
- J Seroussi
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - C Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - A Gillibert
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - R Kania
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - J-P Guichard
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - H Vitaux
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - P Herman
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - E Houdart
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - A Attyé
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital, SFR RMN Neurosciences, 38000 Grenoble, France
| | - M Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France.
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Ward BK, Carey JP, Minor LB. Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years. Front Neurol 2017; 8:177. [PMID: 28503164 PMCID: PMC5408023 DOI: 10.3389/fneur.2017.00177] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/13/2022] Open
Abstract
Superior semicircular canal dehiscence syndrome was first reported by Lloyd Minor and colleagues in 1998. Patients with a dehiscence in the bone overlying the superior semicircular canal experience symptoms of pressure or sound-induced vertigo, bone conduction hyperacusis, and pulsatile tinnitus. The initial series of patients were diagnosed based on common symptoms, a physical examination finding of eye movements in the plane of the superior semicircular canal when ear canal pressure or loud tones were applied to the ear, and high-resolution computed tomography imaging demonstrating a dehiscence in the bone over the superior semicircular canal. Research productivity directed at understanding better methods for diagnosing and treating this condition has substantially increased over the last two decades. We now have a sound understanding of the pathophysiology of third mobile window syndromes, higher resolution imaging protocols, and several sensitive and specific diagnostic tests. Furthermore, we have a treatment (surgical occlusion of the superior semicircular canal) that has demonstrated efficacy. This review will highlight some of the fundamental insights gained in SCDS, propose diagnostic criteria, and discuss future research directions.
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Affiliation(s)
- Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lloyd B. Minor
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Bi WL, Brewster R, Poe D, Vernick D, Lee DJ, Eduardo Corrales C, Dunn IF. Superior semicircular canal dehiscence syndrome. J Neurosurg 2017; 127:1268-1276. [PMID: 28084916 DOI: 10.3171/2016.9.jns16503] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) syndrome is an increasingly recognized cause of vestibular and/or auditory symptoms in both adults and children. These symptoms are believed to result from the presence of a pathological mobile "third window" into the labyrinth due to deficiency in the osseous shell, leading to inadvertent hydroacoustic transmissions through the cochlea and labyrinth. The most common bony defect of the superior canal is found over the arcuate eminence, with rare cases involving the posteromedial limb of the superior canal associated with the superior petrosal sinus. Operative intervention is indicated for intractable or debilitating symptoms that persist despite conservative management and vestibular sedation. Surgical repair can be accomplished by reconstruction or plugging of the bony defect or reinforcement of the round window through a variety of operative approaches. The authors review the etiology, pathophysiology, presentation, diagnosis, surgical options, and outcomes in the treatment of this entity, with a focus on potential pitfalls that may be encountered during clinical management.
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Affiliation(s)
- Wenya Linda Bi
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Ryan Brewster
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
| | - Dennis Poe
- 2Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital.,3Department of Otolaryngology, Harvard Medical School
| | - David Vernick
- 3Department of Otolaryngology, Harvard Medical School
| | - Daniel J Lee
- 3Department of Otolaryngology, Harvard Medical School.,4Department of Otolaryngology, Massachusetts Eye and Ear Infirmary; and.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - C Eduardo Corrales
- 3Department of Otolaryngology, Harvard Medical School.,5Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian F Dunn
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital
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Govender S, Fernando T, Dennis DL, Welgampola MS, Colebatch JG. Properties of 500Hz air- and bone-conducted vestibular evoked myogenic potentials (VEMPs) in superior canal dehiscence. Clin Neurophysiol 2016; 127:2522-31. [DOI: 10.1016/j.clinph.2016.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
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18
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Singh NK, Sinha SK, Barman A. Assessment of otolith mediated neural reflexes through cervical and ocular vestibular evoked myogenic potentials in individuals with auditory neuropathy spectrum disorders. HEARING BALANCE AND COMMUNICATION 2016. [DOI: 10.3109/21695717.2016.1152047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Verrecchia L, Westin M, Duan M, Brantberg K. Ocular vestibular evoked myogenic potentials to vertex low frequency vibration as a diagnostic test for superior canal dehiscence. Clin Neurophysiol 2016; 127:2134-9. [PMID: 26818880 DOI: 10.1016/j.clinph.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 12/24/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore ocular vestibular evoked myogenic potentials (oVEMP) to low-frequency vertex vibration (125 Hz) as a diagnostic test for superior canal dehiscence (SCD) syndrome. METHODS The oVEMP using 125 Hz single cycle bone-conducted vertex vibration were tested in 15 patients with unilateral superior canal dehiscence (SCD) syndrome, 15 healthy controls and in 20 patients with unilateral vestibular loss due to vestibular neuritis. Amplitude, amplitude asymmetry ratio, latency and interaural latency difference were parameters of interest. RESULTS The oVEMP amplitude was significantly larger in SCD patients when affected sides (53 μVolts) were compared to non-affected (17.2 μVolts) or compared to healthy controls (13.6 μVolts). Amplitude larger than 33.8 μVolts separates effectively the SCD ears from the healthy ones with sensitivity of 87% and specificity of 93%. The other three parameters showed an overlap between affected SCD ears and non-affected as well as between SCD ears and those in the two control groups. CONCLUSIONS oVEMP amplitude distinguishes SCD ears from healthy ones using low-frequency vibration stimuli at vertex. SIGNIFICANCE Amplitude analysis of oVEMP evoked by low-frequency vertex bone vibration stimulation is an additional indicator of SCD syndrome and might serve for diagnosing SCD patients with coexistent conductive middle ear problems.
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Affiliation(s)
- Luca Verrecchia
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus Westin
- Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
| | - Maoli Duan
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
| | - Krister Brantberg
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
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Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:133-155. [PMID: 27638068 DOI: 10.1016/b978-0-444-63437-5.00010-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
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Affiliation(s)
- J G Colebatch
- Neuroscience Research Australia and Department of Neurology, Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia.
| | - S M Rosengren
- Neurology Department, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, Australia
| | - M S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney Australia
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21
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Todd NPM, Lee CS. The sensory-motor theory of rhythm and beat induction 20 years on: a new synthesis and future perspectives. Front Hum Neurosci 2015; 9:444. [PMID: 26379522 PMCID: PMC4549635 DOI: 10.3389/fnhum.2015.00444] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/22/2015] [Indexed: 11/30/2022] Open
Abstract
Some 20 years ago Todd and colleagues proposed that rhythm perception is mediated by the conjunction of a sensory representation of the auditory input and a motor representation of the body (Todd, 1994a, 1995), and that a sense of motion from sound is mediated by the vestibular system (Todd, 1992a, 1993b). These ideas were developed into a sensory-motor theory of rhythm and beat induction (Todd et al., 1999). A neurological substrate was proposed which might form the biological basis of the theory (Todd et al., 2002). The theory was implemented as a computational model and a number of experiments conducted to test it. In the following time there have been several key developments. One is the demonstration that the vestibular system is primal to rhythm perception, and in related work several experiments have provided further evidence that rhythm perception is body dependent. Another is independent advances in imaging, which have revealed the brain areas associated with both vestibular processing and rhythm perception. A third is the finding that vestibular receptors contribute to auditory evoked potentials (Todd et al., 2014a,b). These behavioral and neurobiological developments demand a theoretical overview which could provide a new synthesis over the domain of rhythm perception. In this paper we suggest four propositions as the basis for such a synthesis. (1) Rhythm perception is a form of vestibular perception; (2) Rhythm perception evokes both external and internal guidance of somatotopic representations; (3) A link from the limbic system to the internal guidance pathway mediates the “dance habit”; (4) The vestibular reward mechanism is innate. The new synthesis provides an explanation for a number of phenomena not often considered by rhythm researchers. We discuss these along with possible computational implementations and alternative models and propose a number of new directions for future research.
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Affiliation(s)
- Neil P M Todd
- Faculty of Life Science, University of Manchester Manchester, UK
| | - Christopher S Lee
- Department of Psychology, Goldsmiths College, University of London London, UK
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22
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Benamira LZ, Maniakas A, Alzahrani M, Saliba I. Common features in patients with superior canal dehiscence declining surgical treatment. J Clin Med Res 2015; 7:308-14. [PMID: 25780478 PMCID: PMC4356090 DOI: 10.14740/jocmr2105w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/25/2022] Open
Abstract
Background Superior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients’ tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients’ choice of a surgical management over watchful waiting. Methods Sixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting. Results Of these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421). Conclusions The natures of cochleovestibular signs and symptoms were shown to be key factors in patients’ choice of a surgical management whereas paraclinical tests seem to be less significant in the patients’ decision for a surgical treatment.
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Affiliation(s)
- Lina Zahra Benamira
- Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Musaed Alzahrani
- Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Issam Saliba
- Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
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Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BCJ. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol 2014; 23:402-19. [PMID: 25104073 DOI: 10.1044/2014_aja-14-0010] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperacusis can be extremely debilitating, and at present, there is no cure. We provide an overview of the field, and possible related areas, in the hope of facilitating future research. METHOD We review and reference literature on hyperacusis and related areas. We have divided the review into 2 articles. In Part I, we discuss definitions, epidemiology, different etiologies and subgroups, and how hyperacusis affects people. In Part II, we review measurements, models, mechanisms, and treatments, and we finish with some suggestions for further research. RESULTS Hyperacusis encompasses a wide range of reactions to sound, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Many different causes have been proposed, and it will be important to appreciate and quantify different subgroups. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including psychoacoustical measures, questionnaires, and brain imaging. CONCLUSIONS Hyperacusis can make life difficult for many, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.
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Affiliation(s)
| | | | | | | | - Tom Brozoski
- Southern Illinois University School of Medicine, Springfield
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24
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Electrophysiologic Diagnosis of Meniere’s Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0051-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Blake DM, Tomovic S, Vazquez A, Lee HJ, Jyung RW. Cochlear-facial dehiscence--a newly described entity. Laryngoscope 2014; 124:283-9. [PMID: 23712934 DOI: 10.1002/lary.24223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/16/2013] [Accepted: 05/03/2013] [Indexed: 11/07/2022]
Abstract
Dehiscence of the cochlear otic capsule has recently been described as a pathologic entity. We describe two cases of cochlear-facial dehiscence, which are the first reported: a 69-year-old male who complained of hearing loss, autophony, and pulsatile tinnitus and a 41-year-old female who complained of left-sided hearing loss, pulsatile tinnitus, and vertigo. In both, computed tomography (CT) showed bony dehiscence between the facial nerve and cochlea. Cochlear-facial dehiscence is another example of otic capsule dehiscence that produces symptoms of third-window lesions. When patients present with symptoms of third-window lesions and CT does not show superior canal dehiscence, cochlear-facial dehiscence should be considered.
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26
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Semicircular canal dehiscence: Frequency and distribution on temporal bone CT and its relationship with the clinical outcomes. Eur J Radiol 2013; 82:e606-9. [DOI: 10.1016/j.ejrad.2013.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/21/2013] [Accepted: 06/29/2013] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Although the vestibular evoked myogenic potential (VEMP) measured from the cervical muscles (cVEMP, cervical VEMP) is well described and has documented clinical utility, its analogue recorded from the extraocular muscles (oVEMP, ocular VEMP) has been described only recently and is currently emerging as an additional test of otolith function. This review will, therefore, summarize recent developments in VEMP research with a focus on the oVEMP. RECENT FINDINGS Recent studies suggest that the oVEMP is produced by otolith afferents in the superior vestibular nerve division, whereas the cVEMP evoked by sound is thought to be an inferior vestibular nerve reflex. Correspondingly, the oVEMP correlates better with caloric and subjective visual vertical tests than sound-cVEMPs. cVEMPs are more complicated than often thought, as shown by the presence of crossed responses and conflicting results of recent vibration studies. Altered inner ear mechanics produced by the vestibular diseases superior semicircular canal dehiscence and Ménière's disease lead to changes in the preferred frequency of the oVEMP and cVEMP. SUMMARY The oVEMP provides complementary diagnostic information to the cVEMP and is likely to be a useful addition to the diagnostic test battery in neuro-otology.
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Occlusion of the round window: a novel way to treat hyperacusis symptoms in superior semicircular canal dehiscence syndrome. The Journal of Laryngology & Otology 2013; 127:705-7. [PMID: 23732001 DOI: 10.1017/s0022215113001096] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Conductive hyperacusis in superior semicircular canal dehiscence syndrome occurs due to the presence of a 'third window' created by the dehiscence. Reversible blocking of the round window can, in theory, cause a reduction in the compression-related volume displacement, and thereby minimise symptoms of conductive hyperacusis. This study describes a technique of permeatal blocking of the round window. METHOD The tympanomeatal flap is elevated and the round window niche is identified. The round window membrane is subsequently identified and occluded with bone wax, muscle and fascia, in three separate layers. Finally, the tympanomeatal flap is reflected, and an ear wick is inserted. RESULTS Two patients who underwent the procedure reported a reduction in symptoms. Importantly, no Tullio phenomenon was reported post-operation. CONCLUSION Blocking of the round window can be used to control symptoms of superior semicircular canal dehiscence syndrome in patients who present solely with symptoms of conductive hyperacusis. This technique provides an alternative to resurfacing techniques. The procedure is simple to perform, reversible and can be undertaken as day-case surgery.
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Dehiscence of the superior semicircular canal: a review of the literature on its possible pathogenic explanations. Eur Arch Otorhinolaryngol 2013; 271:435-7. [DOI: 10.1007/s00405-013-2497-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/11/2013] [Indexed: 10/27/2022]
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30
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Whelan D, Banerjee A. Re: Superior semicircular canal syndrome should be searching for an alternative pathology. Clin Otolaryngol 2013; 38:101-2. [PMID: 23418975 DOI: 10.1111/coa.12037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/28/2022]
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Milojcic R, Guinan JJ, Rauch SD, Herrmann BS. Vestibular Evoked Myogenic Potentials in Patients With Superior Semicircular Canal Dehiscence. Otol Neurotol 2013; 34:360-7. [DOI: 10.1097/mao.0b013e31827b4fb5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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; 73:365-70. [PMID: 24294552 PMCID: PMC3578588 DOI: 10.1055/s-0032-1324397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
Objectives To review the characteristic symptoms of superior semicircular canal dehiscence, testing and imaging of the disease, and the current treatment and surgical options. Results and Conclusions Symptoms of superior semicircular canal dehiscence (SSCD) include autophony, inner ear conductive hearing loss, Hennebert sign, and sound-induced episodic vertigo and disequilibrium (Tullio phenomenon), among others. Potential etiologies noted for canal dehiscence include possible developmental abnormalities, congenital defects, chronic otitis media with cholesteatoma, fibrous dysplasia, and high-riding jugular bulb. Computed tomography (CT), vestibular evoked myogenic potentials, Valsalva maneuvers, and certain auditory testing may prove useful in the detection and evaluation of dehiscence syndrome. Multislice temporal bone CT examinations are normally performed with fine-cut (0.5- to 0.6-mm) collimation reformatted to the plane of the superior canal such that images are parallel and orthogonal to the plane. For the successful alleviation of auditory and vestibular symptoms, a bony dehiscence can be surgically resurfaced, plugged, or capped through a middle fossa craniotomy or the transmastoid approach. SSCD should only be surgically treated in patients who exhibit clinical manifestations.
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Affiliation(s)
- Andrew Yew
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Golmah Zarinkhou
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Marko Spasic
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Andy Trang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Quinton Gopen
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, United States
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Brantberg K, Verrecchia L. Effectiveness of different click stimuli in diagnosing superior canal dehiscence using cervical vestibular evoked myogenic potentials. Acta Otolaryngol 2012; 132:1077-83. [PMID: 22779948 DOI: 10.3109/00016489.2012.689858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Testing cervical vestibular evoked myogenic potential (cVEMP) in response to 90 dB nHL clicks can, in contrast to high-intensity 500 Hz tone bursts, be used as a screening test for superior canal dehiscence (SCD) syndrome. OBJECTIVES cVEMP testing has its key clinical significance for evaluating saccular and inferior vestibular nerve function, but also for assessment of vestibular hypersensitivity to sounds in patients with SCD syndrome. The routine stimulus used in cVEMP testing is high-intensity 500 Hz tone bursts. The aim of the present study was to compare the high-intensity tone burst stimulation with less intense click stimulations for the diagnosis of SCD syndrome. METHODS cVEMP amplitudes in response to 500 Hz tone bursts and clicks were studied in 38 patients with SCD syndrome unilaterally. RESULTS cVEMP testing using high-intensity 500 Hz tone bursts did not consistently distinguish SCD patients. This nonfunctioning of high-intensity 500 Hz stimulation is most likely due to saturation. With 90 and 80 dB nHL clicks there is low risk for saturation and both these click stimulations were effective. Testing with both 80 and 90 dB nHL clicks did not have any significant advantage over just using 90 nHL dB clicks.
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Affiliation(s)
- Krister Brantberg
- Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
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Niesten MEF, McKenna MJ, Herrmann BS, Grolman W, Lee DJ. Utility of cVEMPs in bilateral superior canal dehiscence syndrome. Laryngoscope 2012; 123:226-32. [PMID: 22991076 DOI: 10.1002/lary.23550] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the utility of cervical vestibular evoked myogenic potential (cVEMP) thresholds in the surgical management of bilateral superior canal dehiscence syndrome (SCDS). STUDY DESIGN Retrospective review. METHODS We identified patients who underwent surgical treatment for SCDS from our database of 147 patients diagnosed with superior canal dehiscence (SCD) between 2000 and 2011 at our institution. The diagnosis of SCDS was based on clinical signs and symptoms, audiometric and cVEMP testing, and high-resolution computed tomography. RESULTS We identified 38 patients who underwent SCD surgery in 40 ears (2 bilateral). In seven patients with bilateral SCD, the more symptomatic ear had lower cVEMP thresholds, a larger air bone gap and a lateralizing tuning fork. In 13 patients with perioperative cVEMP testing, thresholds increased in 12 patients following primary repair, and no threshold shift was seen in one patient with persistence of symptoms after revision surgery. Audiometric data showed a significant mean decrease of the low-frequency air-bone gap and a mild (high-frequency) bone conduction loss after surgical repair. CONCLUSIONS We found that, 1) preoperative cVEMP thresholds, the magnitude of the air-bone gap and tuning-fork testing are important to confirm the worse ear in patients with bilateral SCD, 2) elevation of cVEMP thresholds following surgery correlates with improvement of symptoms and underscores the importance of postoperative testing in patients with bilateral disease or recurrence of symptoms and, 3) SCD plugging is associated with a partial closure of the air-bone gap and a mild (high-frequency) sensorineural hearing loss.
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Affiliation(s)
- Marlien E F Niesten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands
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Tuning of the ocular vestibular evoked myogenic potential (oVEMP) to air- and bone-conducted sound stimulation in superior canal dehiscence. Exp Brain Res 2012; 223:51-64. [DOI: 10.1007/s00221-012-3240-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 08/18/2012] [Indexed: 01/20/2023]
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Teixido M, Kung B, Rosowski JJ, Merchant SN. Histopathology of the temporal bone in a case of superior canal dehiscence syndrome. Ann Otol Rhinol Laryngol 2012; 121:7-12. [PMID: 22312921 DOI: 10.1177/000348941212100102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe the histopathologic findings in the temporal bones of a patient who had, during life, received a diagnosis of superior canal dehiscence (SCD) syndrome. METHODS The patient was found to have SCD syndrome at 59 years of age. She became a temporal bone donor, and died of unrelated causes at 62 years of age. Both temporal bones were prepared in celloidin and examined by light microscopy. RESULTS The patient developed bilateral aural fullness, pulsatile tinnitus, and difficulty tolerating loud noises after minor head trauma at 53 years of age. The symptoms were worse on the right. She also had Valsalva-induced dizziness and eye movements, as well as sound-induced dizziness (more prominent on the right). Audiometry showed a small air-bone gap of 10 dB in the right ear. Vestibular evoked myogenic potential testing showed an abnormally low threshold of 66 dB on the right, and a computed tomography scan showed dehiscence of the superior canal on the right. Histopathologic examination of the right ear showed a 1.4 x 0.6-mm dehiscence of bone covering the superior canal. Dura was in direct contact with the endosteum and the membranous duct at the level of the dehiscence. No osteoclastic process was evident within the otic capsule bone surrounding the dehiscence. The left ear showed thin but intact bone over the superior canal. Both ears showed focal microdehiscences of the tegmen tympani and tegmen mastoideum. The auditory and vestibular sense organs on both sides appeared normal. No endolymphatic hydrops was observed. CONCLUSIONS The findings were consistent with the hypothesis put forth by Carey and colleagues that SCD may arise from a failure of postnatal bone development, and that minor trauma may disrupt thin bone or stable dura over the superior canal.
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Affiliation(s)
- Michael Teixido
- Department of Otolaryngology, Christiana Care Health System, Wilmington, Delaware, USA
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Lee GS, Zhou G, Poe D, Kenna M, Amin M, Ohlms L, Gopen Q. Clinical experience in diagnosis and management of superior semicircular canal dehiscence in children. Laryngoscope 2011; 121:2256-61. [DOI: 10.1002/lary.22134] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 11/07/2022]
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Amoodi HA, Makki FM, McNeil M, Bance M. Transmastoid resurfacing of superior semicircular canal dehiscence. Laryngoscope 2011; 121:1117-23. [PMID: 21520134 DOI: 10.1002/lary.21398] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe a new and fast surgical technique in treating superior semicircular canal dehiscence syndrome by resurfacing the canal defect via the transmastoid approach without retraction of the whole temporal lobe and to demonstrate the clinical and audiologic results of the superior canal dehiscence repair. Superior semicircular canal dehiscence syndrome is a well-described pathology. Surgical procedures through the middle fossa approach to resurface the superior canal and transmastoid plugging are considered the main surgical therapeutic options for patients with debilitating symptoms. Both have drawbacks; plugging is invasive to the inner ear, and resurfacing requires a middle fossa approach. STUDY DESIGN Retrospective review. METHODS Four patients presented with classic symptomatic semicircular canal dehiscence syndrome with radiographic confirmation of their dehiscence. The patients underwent the resurfacing procedure with a transmastoid approach. RESULTS All four patients reported resolution of their symptoms. Audiograms documented some improvement in three subjects. CONCLUSIONS The transmastoid approach for resurfacing superior semicircular canal dehiscence is a safe and less-invasive technique than the standard middle fossa approach, which has many potential complications and requires much longer hospitalization. In our study, the surgeries were completed within 90 minutes, and patients stayed in the hospital only overnight.
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Affiliation(s)
- Hosam A Amoodi
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Attias J, Nageris BI, Shemesh R, Shvero J, Preis M. Superior Canal Dehiscence Effect on Hearing Thresholds. Otolaryngol Head Neck Surg 2011; 145:648-53. [DOI: 10.1177/0194599811410535] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. Superior semicircular dehiscence syndrome is associated with vestibular symptoms and an air–bone gap component in the audiogram, apparently caused by the creation of a pathological bony “third window” in the superior semicircular canal. The aim of this study was to evaluate changes in auditory air- and bone-conduction thresholds to low- and high-frequency stimuli in an animal model of a bony fenestration facing the aerated mastoid cavity. Study Design. Anatomic, audiological. Setting. Tertiary university-affiliated medical center. Animals. A small hole was drilled in the bony apical portion of the superior semicircular canal facing the mastoid bulla/cavity, with preservation of the membranous labyrinth, in 5 adult-size fat sand rats. Main Outcome Measures. Auditory brain stem responses to clicks and 1-kHz tone bursts delivered by air and bone conduction before surgery, after opening the bulla, and after fenestration. Results. After fenestration, a significant air–bone gap was measured in response to clicks (mean ± standard deviation, 37 ± 5.8 dB) and bursts (mean ± standard deviation, 34 ± 14.5 dB). The gap was attributable solely to the significant deterioration in air-conduction thresholds, in the absence of a significant change in bone conduction thresholds. The pattern of auditory brain response changes closely resembled that reported for middle ear dysfunction, namely, an increase in absolute latency of waves I, III, and V without significant alterations in interpeak latency differences. Conclusions. Bony fenestration of the superior semicircular canal toward an aerated cavity in a rodent model mimics the auditory loss pattern of patients with superior semicircular dehiscence syndrome. The dehiscent membrane accounts for the auditory changes.
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Affiliation(s)
- Joseph Attias
- Department of Communication Sciences & Disorders, University of Haifa, Haifa
- Institute for Audiology and Clinical Neurophysiology, Schneider Children’s Medical Center of Israel, Petach Tikva
| | - Ben I. Nageris
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafi Shemesh
- Department of Communication Sciences & Disorders, University of Haifa, Haifa
| | - Jacob Shvero
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Preis
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yuen HW, Boeddinghaus R, Eikelboom RH, Atlas MD. 15th Yahya Cohen Memorial Lecture — The Relationship between the Air-bone Gap and the Size of Superior Semicircular Canal Dehiscence. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n1p59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: This study aimed to examine the relationship between the air-bone gap (ABG) and the size of the superior semicircular canal dehiscence (SSCD) as measured on a computed tomography (CT) scan. Materials and Methods: The study design was a case series with chart review. Twenty-three patients (28 ears) from a tertiary referral centre were diagnosed with SSCD. The size of the dehiscence on CT scans and the ABG on pure-tone audiometry were recorded. Results: The size of the dehiscence ranged from 1.0 to 6.0 mm (mean, 3.5 ± 1.6 mm). Six ears with a dehiscence measuring less than 3.0 mm did not have an ABG (0 dB). The remaining 18 ears showed an average ABG at 500, 1000, and 2000 Hz (AvABG500-2000) ranging from 3.3 to 27.0 dB (mean, 11.6 ± 5.7 dB). The analysis of the relationship between the dehiscence size and AvABG500-2000 revealed a correlation of R2 = 0.828 (P <0.001, quadratic fit) and R2 = 0.780 (P <0.001, linear fit). Therefore, the larger the dehiscence, the larger the ABG at lower frequencies on pure-tone audiometry. Conclusion: In SSCD patients, an ABG is consistently shown at the low frequency when the dehiscence is larger than 3 mm. The size of the average ABG correlates with the size of the dehiscence. These findings highlight the effect of the dehiscence size on conductive hearing loss in SSCD and contribute to a better understanding of the symptomatology of patients with SSCD.
Key words: CT scan, Hyperacusis, Tullio's phenomenon, Vertigo
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Affiliation(s)
- Heng Wai Yuen
- Ear Science Institute Australia, Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | | | - Robert H Eikelboom
- Ear Science Institute Australia, Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Marcus D Atlas
- Ear Science Institute Australia, Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
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Erdogan N, Songu M, Akay E, Mete BD, Uluc E, Onal K, Oyar O. Posterior semicircular canal dehiscence in asymptomatic ears. Acta Otolaryngol 2011; 131:4-8. [PMID: 20807023 DOI: 10.3109/00016489.2010.502184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS This study revealed that, in the adult population, the final diagnosis of this entity can only be made by combining imaging with clinical tests. OBJECTIVE We developed the largest temporal bone multislice computed tomography (CT) scan study so far by including 410 cases to investigate the prevalence of posterior semicircular canal dehiscence in patients with symptoms unrelated to the inner ear. METHODS A prospective study was performed in 410 consecutive adult individuals who underwent temporal bone multislice CT scan examinations. RESULTS The prevalence of posterior semicircular canal dehiscence was determined to be 1.2%. No superior or lateral semicircular canal defect was detected in these five patients. All cases with posterior semicircular canal defect were male. In two cases the canal was located unilaterally, while in three cases the defects were present bilaterally. Otological examination and audiovestibular tests revealed no abnormal findings in any of the individuals.
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Affiliation(s)
- Nezahat Erdogan
- Department of Radiology, Izmir Ataturk Research and Training Hospital, Turkey.
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Yu YF, Zhang YB, Dai CF, Chi FL. Use of the loud sound stimulation test in diagnosis of semicircular canal dehiscence syndrome. Eur Arch Otorhinolaryngol 2010; 268:513-8. [PMID: 21116643 DOI: 10.1007/s00405-010-1433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
Semicircular canal dehiscence (SCD) syndrome is rare, and its diagnosis is a significant challenge in clinical practice. Our aim was to explore application of the loud sound stimulation test for diagnosing SCD syndrome. Eight cases of superior semicircular canal dehiscence (SSCD), among them two patients had bilateral dehiscences and one case of lateral semicircular canal dehiscence (LSCD). A total of 11 dehiscences were studied retrospectively. Loud sounds (pure tones, 100 dB, 110 dB nHL) at frequencies of 500, 1,000, and 2,000 Hz were used to stimulate both ears for 5 s. A temporal bone computed tomography (CT) scan with semicircular canal reconstruction was performed in all patients. Vertigo was present in seven of nine cases following loud sound stimulation. In addition, the patient with LSCD demonstrated horizontal eye movement following loud sound stimulation, whereas six patients with SSCD showed rotational eye movement. Among them, two patients with bilateral superior canal dehiscence showed a positive response to the loud sound stimulation in only one ear. The diagnoses of all patients were confirmed with a high-resolution temporal bone CT with corresponding multi-planar reconstruction of the affected semicircular canals with various size dehiscences. We conclude that the characteristic eye movement following loud sound stimulation is valuable for diagnosing SCD syndrome. In addition, the loud sound stimulation test has unique advantages, especially for confirming the affected ear and the corresponding semicircular canal.
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Affiliation(s)
- Ya-Feng Yu
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
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Vestibular evoked myogenic potentials and health-related quality of life in patients with vestibular neuritis. Otol Neurotol 2010; 31:954-8. [PMID: 20684061 DOI: 10.1097/mao.0b013e3181e8fb32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the usefulness of vestibular evoked myogenic potentials (VEMPs) in subjects with vestibular neuritis (VN) and to determine the impact of the disease in health-related quality of life (HRQoL). STUDY DESIGN Case series. SETTING Tertiary referral center. PATIENTS Fifty patients with VN (episode of sudden onset of prolonged vertigo [>24 h] associated with peripheral vestibular hypofunction, imbalance in absence of hearing loss, or other neurologic symptoms). INTERVENTION VEMPs were measured in 41 patients by using an air-conducted 500 Hz tone burst. HRQoL was evaluated in all cases by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Dizziness Handicap Inventory Short Form (DHI-S) instruments, after the acute episode was resolved. MAIN OUTCOME MEASURE Latencies P1 or N1 peaks, corrected amplitude or the absence of response, for VEMPs; scores obtained in SF-36 and DHI-S instruments. RESULTS VEMPs showed abnormal results in 21 (51%) of 41 cases, with an increase in ipsilateral latencies for P1 and N1 peaks being the most common finding. Three patients (7%) had ipsilateral abnormal VEMP response with normal caloric response, indicating isolated involvement of inferior vestibular nerve. The total score obtained for the DHI-S was 14.76 +/- 11.07 (range, 0-34/40), suggesting a variable impact among patients with VN. For the SF-36, scores in men with VN were worse than their age-matched controls for all dimensions, except for mental health. However, women only showed lower scores for general health and social function. CONCLUSION Abnormal VEMP responses demonstrate the involvement of the inferior vestibular nerve in half of the patients with VN. Moreover, VN has a moderate impact in HRQoL, and it is perceived more disabling by men than women.
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Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol 2010; 31:793-802. [PMID: 20517167 DOI: 10.1097/mao.0b013e3181e3d60e] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the test-retest reliability and age-related trends of the cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP, respectively) responses to air-conducted sound and bone-conducted vibration stimulation. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Fifty-three healthy adults with no hearing or vestibular deficits. INTERVENTION(S) All subjects underwent cVEMP and oVEMP testing in response to sounds (0.1-ms clicks and 500-Hz tone bursts) and vibration (midline forehead taps at the hairline, Fz, with a reflex hammer and a Brüel & Kjaer Mini-Shaker Type 4810). Twelve subjects underwent an additional testing session that was conducted at a mean of 10 weeks after the first one. MAIN OUTCOME MEASURE(S) Test-retest reliability for VEMP response parameters (latency, peak-to-peak amplitude, and asymmetry ratio) were assessed using the intraclass correlation coefficient (ICC). RESULTS : oVEMP amplitudes had excellent test-retest reliability (ICC > 0.75) for all 4 stimuli; cVEMP amplitudes had excellent reliability for hammer taps and fair-to-good reliability for other stimuli. oVEMP asymmetry ratios had excellent reliability for clicks and fair-to-good reliability (ICC = 0.4-0.75) for other stimuli; cVEMP asymmetry ratios had fair-to-good reliability for clicks and hammer taps. Older subjects (>50 years old) were found to have significantly decreased cVEMP amplitudes in response to clicks, tones, and taps with a Mini-Shaker and significantly decreased oVEMP amplitudes in response to clicks, tones, and taps with a reflex hammer. No age-related changes were found for latencies or asymmetry ratios. CONCLUSION Overall, oVEMP response parameters demonstrated better test-retest reliability than cVEMP response parameters, but oVEMPs and cVEMPs had similar age-related changes.
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Salt AN, Hullar TE. Responses of the ear to low frequency sounds, infrasound and wind turbines. Hear Res 2010; 268:12-21. [PMID: 20561575 PMCID: PMC2923251 DOI: 10.1016/j.heares.2010.06.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/07/2010] [Accepted: 06/09/2010] [Indexed: 01/12/2023]
Abstract
Infrasonic sounds are generated internally in the body (by respiration, heartbeat, coughing, etc) and by external sources, such as air conditioning systems, inside vehicles, some industrial processes and, now becoming increasingly prevalent, wind turbines. It is widely assumed that infrasound presented at an amplitude below what is audible has no influence on the ear. In this review, we consider possible ways that low frequency sounds, at levels that may or may not be heard, could influence the function of the ear. The inner ear has elaborate mechanisms to attenuate low frequency sound components before they are transmitted to the brain. The auditory portion of the ear, the cochlea, has two types of sensory cells, inner hair cells (IHC) and outer hair cells (OHC), of which the IHC are coupled to the afferent fibers that transmit "hearing" to the brain. The sensory stereocilia ("hairs") on the IHC are "fluid coupled" to mechanical stimuli, so their responses depend on stimulus velocity and their sensitivity decreases as sound frequency is lowered. In contrast, the OHC are directly coupled to mechanical stimuli, so their input remains greater than for IHC at low frequencies. At very low frequencies the OHC are stimulated by sounds at levels below those that are heard. Although the hair cells in other sensory structures such as the saccule may be tuned to infrasonic frequencies, auditory stimulus coupling to these structures is inefficient so that they are unlikely to be influenced by airborne infrasound. Structures that are involved in endolymph volume regulation are also known to be influenced by infrasound, but their sensitivity is also thought to be low. There are, however, abnormal states in which the ear becomes hypersensitive to infrasound. In most cases, the inner ear's responses to infrasound can be considered normal, but they could be associated with unfamiliar sensations or subtle changes in physiology. This raises the possibility that exposure to the infrasound component of wind turbine noise could influence the physiology of the ear.
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Affiliation(s)
- Alec N Salt
- Department of Otolaryngology, Washington University School of Medicine, Box 8115, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Welgampola MS, Carey JP. Waiting for the evidence: VEMP testing and the ability to differentiate utricular versus saccular function. Otolaryngol Head Neck Surg 2010; 143:281-3. [PMID: 20647135 DOI: 10.1016/j.otohns.2010.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/18/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
The advent of cervical vestibular evoked myogenic potentials (CVEMPs) marked a milestone in clinical vestibular testing because they provided a simple means of assessing human otolith function. The availability of air-conducted (AC) sound and bone-conducted vibration (BCV) to evoke CVEMPs and development of a new technique of recording ocular vestibular-evoked myogenic potentials (OVEMPs) have increased the complexity of this simple test, yet extended its diagnostic capabilities. Here we highlight the evidence-based assumptions that guide interpretation of AC sound- and BCV-evoked VEMPs and the gaps in VEMP research thus far.
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Affiliation(s)
- Miriam S Welgampola
- Otolaryngology-Head and Neck Surgery Department, Johns Hopkins University, Baltimore, MD 21287, USA
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Songer JE, Rosowski JJ. A superior semicircular canal dehiscence-induced air-bone gap in chinchilla. Hear Res 2010; 269:70-80. [PMID: 20638462 DOI: 10.1016/j.heares.2010.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 11/26/2022]
Abstract
An SCD is a pathologic hole (or dehiscence) in the bone separating the superior semicircular canal from the cranial cavity that has been associated with a conductive hearing loss in patients with SCD syndrome. The conductive loss is defined by an audiometrically determined air-bone gap that results from the combination of a decrease in sensitivity to air-conducted sound and an increase in sensitivity to bone-conducted sound. Our goal is to demonstrate, through physiological measurements in an animal model, that mechanically altering the superior semicircular canal (SC) by introducing a hole (dehiscence) is sufficient to cause such an air-bone gap. We surgically introduced holes into the SC of chinchilla ears and evaluated auditory sensitivity (cochlear potential) in response to both air- and bone-conducted stimuli. The introduction of the SC hole led to a low-frequency (<2000 Hz) decrease in sensitivity to air-conducted stimuli and a low-frequency (<1000 Hz) increase in sensitivity to bone-conducted stimuli resulting in an air-bone gap. This result was consistent and reversible. The air-bone gaps in the animal results are qualitatively consistent with findings in patients with SCD syndrome.
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Vestibular evoked myogenic potentials: review. The Journal of Laryngology & Otology 2010; 124:1043-50. [DOI: 10.1017/s0022215110001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Disorders of balance often pose a diagnostic conundrum for clinicians, and a multitude of investigations have emerged over the years. Vestibular evoked myogenic potential testing is a diagnostic tool which can be used to assess vestibular function. Over recent years, extensive study has begun to establish a broader clinical role for vestibular evoked myogenic potential testing.Objectives:To provide an overview of vestibular evoked myogenic potential testing, and to present the evidence for its clinical application.Review type:Structured literature search according to evidence-based medicine guidelines, performed between November 2008 and April 2009. No restrictions were applied to the dates searched.Conclusion:The benefits of vestibular evoked myogenic potential testing have already been established as regards the diagnosis and monitoring of several clinical conditions. Researchers continue to delve deeper into potential new clinical applications, with early results suggesting promising future developments.
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