Document Detail


Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker.
MedLine Citation:
PMID:  17955609     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify otologic and audiologic characteristics of superior (and posterior) semicircular canal dehiscence (SCD). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Sixty-five adult patients were evaluated for SCD; 26 of 65 (35 ears) had dehiscence. INTERVENTION(S): Otologic examination, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and vestibular evoked myogenic potential (VEMP). MAIN OUTCOME MEASURE(S): Imaging demonstrating canal dehiscence, preferentially including Poschel and Stenvers reconstructions. Audiologic findings of pseudoconductive loss, intact ipsilateral stapedial reflex, and abnormally low VEMP thresholds. RESULTS: The most common presenting complaints were autophony of voice and a "blocked ear" (94%), mimicking patulous eustachian tube, including relief with Valsalva or supine position (50%), but without autophony of nasal breathing. Pseudoconductive loss was found in 86% of dehiscence ears, and 60% (21 of 35) of these ears had better than 0-dB-hearing-loss bone conduction thresholds at 250 and/or 500 Hz. Acoustic reflex was present in 89%. Assuming CT as the criterion standard, VEMP resulted in 91.4% sensitivity and 95.8% specificity. One false-positive CT, with abnormal VEMP, resulted in surgical explorations negative for superior SCD but positive for posterior SCD. CONCLUSION: Semicircular canal dehiscence may present with various symptoms such as autophony, ear blockage, and dizziness/vertigo. A combination of high-resolution CT and audiologic testing is recommended for diagnosis. Low-frequency conductive loss with better than 0 dB hearing level (HL) bone conduction threshold and normal tympanometry, with intact acoustic reflexes, are audiologic signs of SCD. Vestibular evoked myogenic potential is highly sensitive and specific for SCD, possibly better than CT.
Authors:
Guangwei Zhou; Quinton Gopen; Dennis S Poe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  28     ISSN:  1531-7129     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-22     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  920-6     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, MA 02115, USA. guangwei.zhou@childrens.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Acoustic Impedance Tests
Adult
Aged
Aging
Audiometry, Pure-Tone
Bone Conduction / physiology
Data Interpretation, Statistical
Diagnosis, Differential
Dizziness / diagnosis,  etiology,  physiopathology
Ear Diseases / diagnosis*,  physiopathology,  radiography
Evoked Potentials / physiology
Female
Humans
Labyrinth Diseases / diagnosis*,  physiopathology,  radiography
Male
Middle Aged
Reflex, Acoustic / physiology
Retrospective Studies
Semicircular Canals*
Supine Position
Tomography, X-Ray Computed
Valsalva Maneuver
Vertigo / diagnosis,  etiology,  physiopathology
Vestibular Function Tests

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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