Audiologic, cVEMP, and Radiologic Progression in Superior Canal Dehiscence Syndrome

Abstract

OBJECTIVE:: To assess the change in hearing, vestibular function, and size of superior canal dehiscence (SCD) in patients with SCD syndrome over time. PATIENTS:: Adult patients with SCD in one or both ears with documented sign and symptom progression, as shown by the medical record, audiometry, cervical vestibular-evoked myogenic potentials (cVEMP), and computed tomography (CT). INTERVENTION:: Audiometry, cVEMPs, and temporal bone CT were performed on patients with high clinical suspicion of disease progression. MAIN OUTCOME MEASURE:: Audiometry (magnitude of the air-bone gap [ABG]), cVEMP (magnitude of the thresholds), and CT scans (size of the superior canal dehiscence) were analyzed. Symptoms were assessed at each clinical visit and before repeat testing. RESULTS:: Retrospective review of 250 patients with SCDS showed three patients with disease progression over time with follow-up testing as outlined above. All patients presented initially with mild symptoms, ABGs, low cVEMP thresholds, and small bony defects of the arcuate eminence. Four, 6, and 8 years later, progression of SCD signs and symptoms was observed in these three patients, respectively. Audiometry showed larger ABGs and lower cVEMP thresholds compared with previous testing. CT showed an increase in bony defect size. CONCLUSION:: Progression of SCD symptoms can be associated with a wider air-bone gap, lower cVEMP thresholds, and a larger bony defect. Prospective studies using validated measures of hearing loss and dizziness in patients who have not yet undergone surgery for SCD will determine the association between specific symptoms and objective test outcomes and how these change over time.