Superior Semicircular Canal Dehiscence Presenting as Postpartum Vertigo

Objective: To describe the clinical and diagnostic features of superior semicircular canal dehiscence (SSCD) in patients with postpartum vertigo. Study Design: Retrospective review, meta-analysis. Setting: Tertiary neurotologic and audiologic center. Patients: Two women who presented with a history of acute postpartum vertigo and SSCD confirmed on high-resolution computed tomography (CT) were included. Our meta-analysis of the surgical SSCD literature comprised a total of 43 patients. Intervention: Patients with postpartum vertigo and SSCD underwent a complete medical evaluation, audiometric testing, CT imaging, magnetic resonance imaging studies, vestibular evoked myogenic potential testing, and laser Doppler vibrometer testing. Case 2 was managed with a middle fossa craniotomy and SSCD repair. Results: The first patient presented with normal hearing and aural fullness, autophony, and sound sensitivity of the left ear. A 1-mm left-sided SSCD was seen on CT imaging. She is being managed conservatively. The second patient had left-sided conductive hearing loss with sound and pressure sensitivity. The contralateral ear was congenitally deaf. CT imaging revealed a 4-mm left-sided SSCD. Because of her disabling symptoms, the patient underwent a middle fossa craniotomy and superior canal plugging. Her vestibular symptoms resolved with improvement in hearing. Vestibular evoked myogenic potential and laser Doppler vibrometer testing in both cases were consistent with SSCD. Conclusion: This is the first description of patients with SSCD presenting after childbirth and should be included in the differential diagnosis of acute postpartum vertigo or disequilibrium. SSCD plugging can provide a stable repair with resolution of symptoms, reversal of diagnostic indicators, and hearing improvement.

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

[2]  J. Rosowski,et al.  The effect of superior canal dehiscence on cochlear potential in response to air-conducted stimuli in chinchilla , 2005, Hearing Research.

[3]  S. Cheung,et al.  Management of Superior Canal Dehiscence Syndrome with Extensive Skull-Base Deficiency , 2005, ORL.

[4]  L. Minor.  Clinical Manifestations of Superior Semicircular Canal Dehiscence , 2005, The Laryngoscope.

[5]  A. Ishiyama,et al.  Drop attacks secondary to superior canal dehiscence syndrome , 2005, Neurology.

[6]  C. D. Della Santina,et al.  Superior Canal Dehiscence Is Not Due to Cephalic Displacement of the Labyrinth , 2005, Annals of the New York Academy of Sciences.

[7]  D. Poe,et al.  Operative Management of Superior Semicircular Canal Dehiscence , 2005, The Laryngoscope.

[8]  Saumil N Merchant,et al.  Clinical, Experimental, and Theoretical Investigations of the Effect of Superior Semicircular Canal Dehiscence on Hearing Mechanisms , 2004, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[9]  P. Fransson,et al.  Large Vestibular Evoked Myogenic Potentials in Response to Bone-Conducted Sounds in Patients with Superior Canal Dehiscence Syndrome , 2004, Audiology and Neurotology.

[10]  S. Merchant,et al.  Superior Semicircular Canal Dehiscence Presenting as Conductive Hearing Loss Without Vertigo , 2004, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[11]  Saumil N Merchant,et al.  A normative study of tympanic membrane motion in humans using a laser Doppler vibrometer (LDV) , 2004, Hearing Research.

[12]  Jonathan E. Martin,et al.  Superior semicircular canal dehiscence: a new indication for middle fossa craniotomy. Case report. , 2004, Journal of neurosurgery.

[13]  M. McKenna,et al.  Superior semicircular canal dehiscence syndrome. Case report. , 2004, Journal of neurosurgery.

[14]  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.

[15]  L. Minor.  Labyrinthine fistulae: pathobiology and management , 2003, Current opinion in otolaryngology & head and neck surgery.

[16]  D. Hunter.  Coenzyme Q10 in early Parkinson disease. , 2003, Archives of neurology.

[17]  Kenneth M. Cox,et al.  Dehiscence of bone overlying the superior semicircular canal as a cause of an air-bone gap on audiometry: a case study. , 2003, American journal of audiology.

[18]  R. A. Yavor,et al.  The click-evoked vestibulo-ocular reflex in superior semicircular canal dehiscence , 2003, Neurology.

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

[20]  L. Minor,et al.  Dehiscence of Bone Overlying the Superior Canal as a Cause of Apparent Conductive Hearing Loss , 2003, Otology and Neurotology.

[21]  John J. Rosowski,et al.  Diagnostic Utility of Laser-Doppler Vibrometry in Conductive Hearing Loss with Normal Tympanic Membrane , 2003, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[22]  S James Zinreich,et al.  CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo. , 2003, Radiology.

[23]  R. Brey,et al.  Rotatory nystagmus synchronous with heartbeat: a treatable form of nystagmus. , 2003, Transactions of the American Ophthalmological Society.

[24]  T. Hirvonen,et al.  Superior canal dehiscence: mechanisms of pressure sensitivity in a chinchilla model. , 2001, Archives of otolaryngology--head & neck surgery.

[25]  A. Tribukait,et al.  Symptoms, findings and treatment in patients with dehiscence of the superior semicircular canal. , 2001, Acta oto-laryngologica.

[26]  L. Minor,et al.  Vestibular-Evoked Myogenic Potentials in the Diagnosis of Superior Canal Dehiscence Syndrome , 2001, Acta oto-laryngologica. Supplementum.

[27]  J P Carey,et al.  Eye movements in patients with superior canal dehiscence syndrome align with the abnormal canal , 2000, Neurology.

[28]  J. Colebatch,et al.  Vestibular hypersensitivity to sound (Tullio phenomenon) , 2000, Neurology.

[29]  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.

[30]  A. Tribukait,et al.  Vestibular-evoked myogenic potentials in patients with dehiscence of the superior semicircular canal. , 1999, Acta oto-laryngologica.

[31]  G. Gianoli,et al.  Superior semicircular canal dehiscence: a new cause of vertigo. , 1999, The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society.

[32]  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.

[33]  K. Chaloner,et al.  Changes in women's physical health during the first postpartum year. , 1993, Archives of family medicine.