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: 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 3

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

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

Labyrinth 1.4mm/year per perez et al. 6 6

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

Tullio Phenomenon

Histopathologic Findings 1000 huesos temporales 1.4% 0.7% Carey, Arch Oto-HNS, 2000 9 9

Etiology Congenital / Development Defect Trauma Microfractures Meningeal Pulsations 1000 huesos temporales Carey, Arch Oto-HNS, 2000 10 10

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

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 12 12

CT Special cuts Stenver’s: Ortogonal 13 13

CT Stenver’s: Ortogonal 14 14

CT Stenver’s: Orthogonal 15 15

CT Stenver’s: Orthogonal 16 16

CT Stenver’s: Orthogonal 17 17

CT Posch’s: Parallel 18 18

CT Posch’s: Parallel 19 19

CT Posch’s: Parallel 20 20

CT Posch’s: Parallel 21 21

CT Posch’s: Parallel 22 22

CT Posch’s: Parallel 23 23

CT Posch’s: Parallel 24 24

Treatment Observation SSC Resurfacing SSC Plugging Middle Fossa Approach SSC Plugging Transmastoid Approach After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. 25 25

SSCD Middle Fossa Plugging After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. Crane, Gasscock, 2010 26 26

SSCD Middle Fossa Plugging After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. Crane, Gasscock, 2010 27 27

SSCD Middle Fossa Plugging After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. Crane, Gasscock, 2010 28 28

SSCD Middle Fossa Plugging After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. Crane, Gasscock, 2010 29 29

SSCD Middle Fossa Plugging After approval was obtained from the Vanderbilt University Institutional Review Board, we performed an ICD-9 database search for patients seen for diagnoses Glomus Jugulare. A total of 161 patients were identified over a 40 year period (1970-2010). Exclusion criteria included all patients with previous surgery or radiation, recurrent glomus jugulare, concurrent carotid body tumors, diagnosis of glomus tympanicum, malignant paraganglioma, and multiple paragangliomas Associations of pre-operative and intra-operative factors with cranial nerve neuropathies were assessed using Chi-Square Tests. To further investigate these associations, logistic regression analysis was conducted. 30 30

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

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