Superior Semicircular Canal Dehiscence in Patients with Spontaneous Cerebrospinal Fluid Otorrhea

Objective To determine the prevalence of superior semicircular canal dehiscence (SCD) in patients with spontaneous cerebrospinal fluid (CSF) otorrhea. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods Patients included have undergone a middle fossa craniotomy for repair of spontaneous CSF otorrhea between January 2007 and December 2011. The main outcome measure is the presence or absence of SCD observed during spontaneous CSF leak repair. Computed tomography (CT) imaging was also reviewed to determine the diagnostic accuracy of this modality. Results Thirty-three ears in 31 patients underwent surgical repair for spontaneous CSF otorrhea via a middle fossa craniotomy. The average age at the time of repair was 60.5 years, and 80.6% of patients were female. A dehiscence of the superior canal was observed in 15.2% of ears (16.1% of individuals). No significant difference in age, body mass index, or sex was noted between those patients with or without a superior canal dehiscence. For the diagnosis of SCD, coronal CT was 100% sensitive and 91.7% specific. The positive predictive value and negative predictive value of CT were 66.7% and 100%, respectively. Conclusion The prevalence of superior semicircular canal dehiscence in ears with spontaneous otorrhea is 15.2%. This prevalence is greater than the 0.5% reported in a temporal bone study of ears not selected for CSF otorrhea.

[1]  J. Carey,et al.  Is superior canal dehiscence congenital or acquired? A case report and review of the literature. , 2011, Otolaryngologic clinics of North America.

[2]  Y. Masaki.  The prevalence of superior canal dehiscence syndrome as assessed by temporal bone computed tomography imaging , 2011, Acta oto-laryngologica.

[3]  T. Clenney,et al.  The association between semicircular canal dehiscence and Chiari type I malformation. , 2010, Archives of otolaryngology--head & neck surgery.

[4]  T. Lesser,et al.  'Honeycomb' tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence. , 2010, The Journal of laryngology and otology.

[5]  P. Roland,et al.  Management of Spontaneous Cerebrospinal Fluid Otorrhea , 2008, The Laryngoscope.

[6]  J. Kveton,et al.  Relationship Between Obesity, Obstructive Sleep Apnea, and Spontaneous Cerebrospinal Fluid Otorrhea , 2008, The Laryngoscope.

[7]  K. Sie,et al.  Labyrinthine dehiscence in a child , 2008, Pediatric Radiology.

[8]  Guangwei Zhou,et al.  Superior semicircular canal dehiscence in a young child: implication of developmental defect. , 2007, International journal of pediatric otorhinolaryngology.

[9]  J. Sheehan,et al.  Idiopathic temporal bone encephaloceles in the obese patient , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[10]  D. Baguley,et al.  Superior semicircular canal dehiscence with a large tegmental defect , 2006, The Journal of Laryngology & Otology.

[11]  B. Branstetter,et al.  Superior semicircular canal dehiscence: oblique reformatted CT images for diagnosis. , 2006, Radiology.

[12]  S. Wetmore,et al.  Diagnosis and Management of Spontaneous Cerebrospinal Fluid Otorrhea , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[13]  N. J. Coker,et al.  Coronal computed tomography prevalence of superior semicircular canal dehiscence. , 2003, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  T. Hirvonen,et al.  High-resolution CT Findings Suggest a Developmental Abnormality Underlying Superior Canal Dehiscence Syndrome , 2003, Acta oto-laryngologica.

[15]  J P Carey,et al.  Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. , 2000, Archives of otolaryngology--head & neck surgery.

[16]  L. Minor.  Superior canal dehiscence syndrome. , 2000, The American journal of otology.

[17]  R. Gacek,et al.  Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. , 1999, The American journal of otology.

[18]  R. Gacek.  The pathology of facial and vestibular neuronitis. , 1999, American journal of otolaryngology.

[19]  D. Zee,et al.  Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. , 1998, Archives of otolaryngology--head & neck surgery.