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Superior Semicircular Canal Dehiscence Update

Superior Semicircular Canal Dehiscence Update. Alejandro Rivas MD Assistant Professor Division of Otology-Neurotology and Skull Base Surgery Dept. of Otolaryngology- Vanderbilt University. Conflict of Interest. Alejandro Rivas None. HA. 48 yo F ice skater trainer:

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Superior Semicircular Canal Dehiscence Update

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  1. Superior Semicircular Canal Dehiscence Update Alejandro Rivas MD Assistant Professor Division of Otology-Neurotology and Skull Base Surgery Dept. of Otolaryngology- Vanderbilt University

  2. Conflict of Interest • Alejandro Rivas • None

  3. HA • 48 yo F ice skater trainer: • Multiple head concussion • Conductive hearing loss • “I can hear my own voice”, “I can hear my eyes move” • Dizziness • Dx: Non specific post-concussion Dizziness for 3 years

  4. CC • 20 M, college football player, • h/o of head traumas • Oscillopsia and disequilibrium during physical activities. • “Eyes jump while weight lifting ”

  5. AS Conductive Hearing loss Autophony Ear Fullness Pulsatile Tinnitus 72 yo M s/p MVA and head concussion • Oscillopsia • Disequilibrium • Dizziness- “eyes jump” on • Valsalva • Loud Noises • Hyperventilation

  6. Labyrinth

  7. Physiopathology Crane, Gasscock, 2010 White, Otol Neurotol, 2007

  8. Tullio Phenomenon

  9. Histopathologic Findings 1.4% 0.7% Carey, Arch Oto-HNS, 2000

  10. Etiology • Congenital / Development Defect • Trauma • Microfractures • Meningeal Pulsations Carey, Arch Oto-HNS, 2000

  11. Clinical Diagnosis • History and physical exam • Audiometry • Mixed or conductive hearing loss • Present stapedial reflex, present OAE • VEMPs: Screening • ECoG

  12. CT confirms the diagnosis • CT based diagnosis alone • High false positive • 4% present SSCD on CT • 0.6-.07% present SSCD on temporal bone cadaveric studies Carey, Arch Oto-HNS, 2000

  13. CT • Special cuts Stenver’s: Ortogonal

  14. CT Stenver’s: Ortogonal

  15. CT Stenver’s: Orthogonal

  16. CT Stenver’s: Orthogonal

  17. CT Stenver’s: Orthogonal

  18. CT • Posch’s: Parallel

  19. CT • Posch’s: Parallel

  20. CT • Posch’s: Parallel

  21. CT • Posch’s: Parallel

  22. CT • Posch’s: Parallel

  23. CT • Posch’s: Parallel

  24. CT • Posch’s: Parallel

  25. Treatment • Observation • SSC Resurfacing • Middle Fossa Approach • SSC Plugging • Middle Fossa Approach • Transmastoid Approach

  26. SSCD Middle Fossa Plugging Crane, Gasscock, 2010

  27. SSCD Middle Fossa Plugging Crane, Gasscock, 2010

  28. SSCD Middle Fossa Plugging Crane, Gasscock, 2010

  29. SSCD Middle Fossa Plugging Crane, Gasscock, 2010

  30. SSCD Middle Fossa Plugging

  31. Results 95% improvement of symptoms 10% decrease funcion in PSC. 3% Unilateral vestibular weakness 3% Decrease hearing.

  32. Thank You

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