Transforming Superior Canal Dehiscence to Chronic Subjective Dizziness: From SCD to CSD

Clinical Observation on the Treatment of Chronic Subjective Dizziness by the Herbal-Scraping Duplex Method Based on Holographic Theory

Chronic subjective dizziness (CSD) is a chronic, subjective, nonrotational dizziness and instability caused by mental or physical factors, and patients generally have no existing vestibular system diseases. Clinically, antianxiety drugs are often used for symptomatic treatment with mediocre effects. This study observed the clinical efficacy of the herbal-scraping duplex method in the treatment of CSD based on the holographic theory. 180 patients with CSD were randomly and equally divided into group A (n = 60) who received fluoxetine hydrochloride, group B (n = 60) who received fluoxetine hydrochloride combined with holographic soup, and group C (n = 60) who received fluoxetine hydrochloride, holographic soup, and holographic scraping combined with five-element music. The effects of the 3 different treatment modalities on patients’ vertigo symptoms, traditional Chinese medicine (TCM) symptoms, anxiety and depression status, sleep quality, and fatigue level were observed. The safety of medication and the recurrence after discontinuation were observed. The results showed that group C was better than group B and group A in terms of improvement in all of the above indicators, and group B was better than group A ( $P<0.05$ ). The total efficiency of Chinese and Western medicine was better in groups C and B than in group A ( $P<0.05$ ). No statistical difference was seen in the comparison of adverse reaction rates between the 3 groups ( $P>0.05$ ). After 1 month of drug discontinuation, the recurrence rates in groups C and B were lower than those in group A ( $P<0.05$ ). This suggests that the clinical efficacy and safety of applying the herbal-scraping duplex method based on holographic theory for the treatment of CSD is ideal and has the value of promotion.

Transmastoid resurfacing versus middle fossa plugging for repair of superior canal dehiscence: Comparison of techniques from a retrospective cohort

Objective

To compare and contrast our experience with middle cranial fossa approach (MFR) and transmastoid approach with capping of the dehiscence (TMR) of superior semicircular canal dehiscence and to determine guidelines to help guide management of these patients.

Methods

All patients from 2005 to 2014 with symptomatic superior semicircular canal dehiscence syndrome with dehiscence demonstrated on CT scan of the temporal bone who underwent surgical repair and had a minimum 3 months of follow up. Surgical repair via the MFR or TMR, preoperative CT temporal bone, preoperative, and postoperative cervical vestibular evoked myogenic potential (cVEMP) testing and anterior canal video head thrust testing (vHIT). Success of repair was stratified as complete success, moderate success, mild success, or failure based on resolution of all symptoms, the chief complaint, some symptoms, or no improvement, respectively.

Results

A total of 29 ears in 27 patients underwent surgical repair of canal dehiscence. Complete or moderate success was seen in 71% of the MFR group compared to 80% of the TMR group. There were zero failures with the MFR group and no major intracranial complications. There were 2 failures out of 15 ears that underwent the TMR. Residual symptoms were most commonly vertigo or disequilibrium in the MFR and aural fullness or autophony in the TMR groups, respectively. MFR hospital stay was approximately 2 days longer. Average cVEMP threshold shifted 18 dB with surgical correction in the MFR group. A 29 dB average shift was seen in the TMR group. The MFR group had a significant reduction in their anterior canal gain compared to the TMR group.

Conclusions

TMR is a less invasive alternative to MFR. However, in our series, we have not seen any intracranial complications (aphasia, stroke, seizures, etc.) in our MFR patients. Interestingly, vestibular symptoms were better addressed than audiological symptoms by the TMR suggesting its usefulness as a less invasive option for patients with primarily vestibular complaints. Residual auditory symptoms in TMR patients may be due to the flow of acoustic energy from the superior canal to the mastoid cavity through an incompletely sealed third window.