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Superior semicircular canal dehiscence: a narrative review

Part of: JLO Editors' Choice Papers 2022

Published online by Cambridge University Press:  07 October 2021

G Kontorinis  and
T Lenarz
G Kontorinis*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
T Lenarz
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hanover Medical School, Hanover, Germany
*
Author for correspondence: Mr Georgios Kontorinis, Department of Otorhinolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK E-mail: gkontorinis@gmail.com
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Abstract

Background

Described just over 20 years ago, superior semicircular canal dehiscence remains a relatively unknown and easily missed cause of dizziness and auditory symptoms.

Objective

This review focused on the origin, presenting symptoms and underlying pathophysiology of superior semicircular canal dehiscence, and the available treatment options.

Main findings and conclusion

The bony dehiscence acts as a ‘third window’, affecting inner-ear homeostasis, and resulting in hypersensitivity and a vestibular response to lower sound level stimuli. The third window effect explains the pressure- and sound-induced vertigo, oscillopsia, and nystagmus, as well as autophony, conductive hyperacusis and tinnitus. The origin of superior semicircular canal dehiscence is linked to the combination of a congenital or developmental factor, and a ‘second event’ like head trauma, rapid pressure changes or age-related factors. Computed tomography of the temporal bone and reduced vestibular-evoked myogenic potential thresholds can confirm the diagnosis. Despite only retrospective cohorts, surgery is considered a safe treatment option, targeting mainly vestibular but also auditory symptoms, with transmastoid approaches gaining popularity.

Keywords

DizzinessHearing LossLabyrinthVertigoVestibular Evoked Myogenic Potential
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 4 , April 2022 , pp. 284 - 292
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr G Kontorinis takes responsibility for the integrity of the content of the paper

References

Neuhauser, HK, Von Brevern, M, Radtke, A, Lezius, F, Feldmann, M, Ziese, T et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005;65:898–90410.1212/01.wnl.0000175987.59991.3dCrossRefGoogle ScholarPubMed
Ludman, H. Vertigo and imbalance. BMJ 2014;348:g283CrossRefGoogle ScholarPubMed
Ibekwe, TS, Fasunla, JA, Ibekwe, PU, Obasikene, GC, Onakoya, PA, Nwaorgu, OG. Migraine and Meniere's disease: two different phenomena with frequently observed concomitant occurrences. J Natl Med Assoc 2008;100:334–8Google ScholarPubMed
Sajjadi, H, Paparella, MM. Meniere's disease. Lancet 2008;372:406–1410.1016/S0140-6736(08)61161-7CrossRefGoogle ScholarPubMed
Baloh, RW. Vertigo. Lancet 1998;352:1841–6CrossRefGoogle ScholarPubMed
Furman, JM, Cass, SP. Benign paroxysmal positional vertigo. N Engl J Med 1999;341:1590–6CrossRefGoogle ScholarPubMed
Kontorinis, G, Tyagi, A, Crowther, JA. Recurrent vertigo associated with headaches. BMJ 2018;363:k1807CrossRefGoogle ScholarPubMed
Minor, LB, Solomon, D, Zinreich, JS, Zee, DS. Sound- and/or pressure-induce vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 1998;124:249–5810.1001/archotol.124.3.249CrossRefGoogle ScholarPubMed
Carey, JP, Minor, LB, Nager, GT. Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg 2000;126:137–4710.1001/archotol.126.2.137CrossRefGoogle ScholarPubMed
Williamson, RA, Vrabec, JT, Coker, NJ, Sandlin, M. Coronal computed tomography prevalence of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 2003;129:41–910.1016/S0194-5998(03)01391-3CrossRefGoogle ScholarPubMed
Schutt, CA, Neubauer, P, Samy, RN, Pensak, ML, Kuhn, JJ, Herschovitch, M et al. The correlation between obesity, obstructive sleep apnea, and superior semicircular canal dehiscence: a new explanation for an increasingly common problem. Otol Neurotol 2015;36:551–410.1097/MAO.0000000000000555CrossRefGoogle ScholarPubMed
Nadgir, RN, Ozonoff, A, Devaiah, AK, Halderman, AA, Sakai, O. Superior semicircular canal dehiscence: congenital or acquired condition? AJNR Am J Neuroradiol 2011;32:947–9CrossRefGoogle ScholarPubMed
Sugihara, EM, Babu, SC, Kitsko, DJ, Haupert, MS, Thottam, PJ. Incidence of pediatric superior semicircular canal dehiscence and inner ear anomalies: a large multicenter review. Otol Neurotol 2016;37:1370–5CrossRefGoogle ScholarPubMed
Zhou, G, Gopen, Q, Poe, DS. Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker. Otol Neurotol 2007;28:920–6CrossRefGoogle ScholarPubMed
Jackson, NM, Allen, LM, Morell, B, Carpenter, CC, Givens, VB, Kakade, A et al. The relationship of age and radiographic incidence of superior semicircular canal dehiscence in pediatric patients. Otol Neurotol 2015;36:99–10510.1097/MAO.0000000000000660CrossRefGoogle ScholarPubMed
Saxby, AJ, Gowdy, C, Fandiño, M, Chadha, N, Kozak, FK, Sargent, MA et al. Radiological prevalence of superior and posterior semicircular canal dehiscence in children. Int J Pediatr Otorhinolaryngol 2015;79:411–18CrossRefGoogle ScholarPubMed
Sood, D, Rana, L, Chauhan, R, Shukla, R, Nandiolia, K. Superior semicircular canal dehiscence: a new perspective. Eur J Radiol Open 2017;4:144–610.1016/j.ejro.2017.10.003CrossRefGoogle ScholarPubMed
Minor, LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 2005;115:1717–2710.1097/01.mlg.0000178324.55729.b7CrossRefGoogle ScholarPubMed
Minor, LB. Superior canal dehiscence syndrome. Am J Otol 2000;21:9–19CrossRefGoogle ScholarPubMed
Ziylan, F, Kinaci, A, Beynon, AJ, Kunst, HP. A comparison of surgical treatments for superior semicircular canal dehiscence: a systematic review. Otol Neurotol 2017;38:1–10CrossRefGoogle ScholarPubMed
Tsunoda, A, Terasaki, O. Dehiscence of the bony roof of the superior semicircular canal in the middle cranial fossa. J Laryngol Otol 2002;116:514–1810.1258/002221502760132377CrossRefGoogle ScholarPubMed
Chilvers, G, McKay-Davies, I. Recent advances in superior semicircular canal dehiscence syndrome. J Laryngol Otol 2015;129:217–25CrossRefGoogle ScholarPubMed
Martin, C, Chahine, P, Veyret, C, Richard, C, Prades, JM, Pouget, JF. Prospective radiological study concerning a series of patients suffering from conductive or mixed hearing loss due to superior semicircular canal dehiscence. Eur Arch Otorhinolaryngol 2009;266:1175–81CrossRefGoogle ScholarPubMed
Sohmer, H, Freeman, S, Perez, R. Semicircular canal fenestration – improvement of bone- but not air-conducted auditory thresholds. Hear Res 2000;187:105–1010.1016/S0378-5955(03)00335-6CrossRefGoogle Scholar
Hiroven, TP, Carey, JP, Liang, CJ, Minor, LB. Superior canal dehiscence: mechanisms of pressure sensitivity in a chinchilla model. Arch Otolaryngol Head Neck Surg 2001;127:1331–610.1001/archotol.127.11.1331CrossRefGoogle Scholar
Pisano, DV, Niesten, ME, Merchant, SN, Nakajima, HH. The effect of superior semicircular canal dehiscence on intracochlear sound pressures. Audiol Neurootol 2012;17:338–48CrossRefGoogle ScholarPubMed
Rosowski, JJ, Songer, JE, Nakajima, HH, Brinsko, KM, Merchant, SN. Clinical, experimental, and theoretical investigations of the effect of superior semicircular canal dehiscence on hearing mechanisms. Otol Neurotol 2004;25:323–32CrossRefGoogle ScholarPubMed
Lenarz, T. Tympanoplastik. In: Boenninghaus, Lenarz, eds. HNO, 13th edn. Heidelberg: Springer, 2007;88–9Google Scholar
Eshraghi, AA, Telischi, FF. Otosclerosis and stapes surgery. Otolaryngol Clin North Am 2018;51:xvii–xix10.1016/j.otc.2017.12.001CrossRefGoogle ScholarPubMed
Nazarian, R, McElveen, JT Jr, Eshraghi, AA. History of otosclerosis and stapes surgery. Otolaryngol Clin North Am 2018;51:275–90CrossRefGoogle ScholarPubMed
Chien, W, Janky, KL, Minor, LB, Carey, J. Superior canal dehiscence size: multivariate assessment of clinical impact. Otol Neurotol 2012;33:810–15CrossRefGoogle ScholarPubMed
Yuen, HW, Boeddinghaus, R, Eikelboom, RH, Atlas, MD. The relationship between the air-bone gap and the size of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 2009;141:689–94CrossRefGoogle ScholarPubMed
Lookabaugh, S, Niesten, ME, Owoc, M, Kozin, ED, Grolman, W, Lee, DJ. Audiologic, cVEMP, and radiologic progression in superior canal dehiscence syndrome. Otol Neurotol 2016;37:1393–8CrossRefGoogle ScholarPubMed
Niesten, MEF, Hamberg, L, Silverman, J, Lou, KV, McCall, AA, Windsor, A et al. Association of size and location of superior canal dehiscence with clinical presentation, audiometric and vestibular testing. Audiol Neurotol 2014;19:97–10510.1159/000353920CrossRefGoogle Scholar
Niesten, ME, Stieger, C, Lee, DJ, Merchant, JP, Grolman, W, Rosowski, JJ et al. Assessment of the effects of superior canal dehiscence location and size on intracochlear sound pressures. Audiol Neurootol 2015;20:62–7110.1159/000366512CrossRefGoogle ScholarPubMed
Ward, BK, Wenzel, A, Ritzl, EK, Gutierrez-Hernandez, S, Della Santina, CC, Minor, LB et al. Near-dehiscence: clinical findings in patients with thin bone over the superior semicircular canal. Otol Neurotol 2013;34:1421–8CrossRefGoogle ScholarPubMed
Lookabaugh, S, Kelly, HR, Carter, MS, Niesten, MEF, McKenna, MJ, Curtinet, H et al. Radiologic classification of superior canal dehiscence: implications for surgical repair. Otol Neurotol 2015;36:118–2510.1097/MAO.0000000000000523CrossRefGoogle ScholarPubMed
Whyte Orozco, J, Martinez, C, Cisneros, A, Obon, J, Gracia-Tello, B, Angel Crovetto, M. Defect of the bony roof in the superior semicircular canal and its clinical implications [in Spanish]. Acta Otorrinolaringol Esp 2011;62:199–20410.1016/j.otorri.2010.11.009CrossRefGoogle Scholar
Takahashi, N, Tsunoda, A, Shirakura, S, Kitamura, K. Anatomical feature of the middle cranial fossa in fetal periods: possible etiology of superior canal dehiscence syndrome. Acta Otolaryngol 2012;132:385–9010.3109/00016489.2011.637234CrossRefGoogle ScholarPubMed
Suryanarayanan, R, Lesser, TH. ‘Honeycomb’ tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence. J Laryngol Otol 2010;124:560–3CrossRefGoogle ScholarPubMed
Nadaraja, GS, Gurgel, RK, Fischbein, NJ, Anglemyer, A, Monfared, A, Jackler, RK et al. Radiographic evaluation of the tegmen in patients with superior semicircular canal dehiscence. Otol Neurotol 2012;33:1245–50CrossRefGoogle ScholarPubMed
Gracia-Tello, B, Cisneros, A, Crovetto, R, Martinez, C, Rodriguez, O, Lecumberri, I et al. Effect of semi-circular canal dehiscence on contralateral canal bone thickness. Acta Otorrinolaringol Esp 2013;64:97–10110.1016/j.otorri.2012.10.004CrossRefGoogle Scholar
Oh, MS, Vivas, EX, Hudgins, PA, Mattox, DE. The prevalence of superior semicircular canal dehiscence in patients with mastoid encephalocele or cerebrospinal fluid otorrhea. Otol Neurotol 2019;40:485–90CrossRefGoogle ScholarPubMed
Tikka, T, Kontorinis, G. Temporal bone anatomy in superior semicircular canal dehiscence: a case control study on bone pneumatization and the level of middle cranial fossa. Otol Neurotol 2020;41:e334–4110.1097/MAO.0000000000002522CrossRefGoogle Scholar
Meiklejohn, DA, Corrales, CE, Boldt, BM, Sharon, JD, Yeom, KW, Carey, JP et al. Pediatric semicircular canal dehiscence: radiographic and histologic prevalence, with clinical correlation. Otol Neurotol 2015;36:1383–9CrossRefGoogle ScholarPubMed
Lagman, C, Ong, V, Chung, LK, Elhajjmoussa, L, Fong, C, Wang, AC et al. Pediatric superior semicircular canal dehiscence: illustrative case and systematic review. J Neurosurg Pediatr 2017;20:196–203CrossRefGoogle ScholarPubMed
Crovetto, MA, Whyte, J, Rodriguez, OM, Lecumberri, I, Martinez, C, Fernandez, C et al. Influence of aging and menopause in the origin of the superior semicircular canal dehiscence. Otol Neurotol 2012;33:681–4CrossRefGoogle ScholarPubMed
Nguyen, T, Lagman, C, Sheppard, JP, Duong, C, Ong, V, Poon, J et al. Bone metabolic markers in the clinical assessment of patients with superior semicircular canal dehiscence. World Neurosurg 2018;114:e42–50CrossRefGoogle ScholarPubMed
Nguyen, T, Sheppard, JP, Duong, C, Ding, K, Dejam, D, Alkhalid, Y et al. Age and gender considerations on the symptomology in patients with superior semicircular canal dehiscence: a systematic review and case illustration. J Clin Neurosci 2019;65:112–2010.1016/j.jocn.2019.04.006CrossRefGoogle ScholarPubMed
Mahulu, EN, Fan, X, Ding, S, Quaye, PJ, Mambo, AM, Mafuru, MM et al. The variation of superior semicircular canal bone thickness in relation to age and gender. Acta Otolaryngol 2019;139:473–8CrossRefGoogle ScholarPubMed
Sørensen, MS, Frisch, T, Bretlau, P. Dynamic bone studies of the labyrinthine capsule in relation to otosclerosis. Adv Otorhinolaryngol 2007;65:53–8Google ScholarPubMed
Thys, M, Van Camp, G. Genetics of otosclerosis. Otol Neurotol 2009;30:1021–32CrossRefGoogle ScholarPubMed
El Hadi, T, Sorrentino, T, Calmels, MN, Fraysse, B, Deguine, O, Marx, M. Spontaneous tegmen defect and semicircular canal dehiscence: same etiopathogenic entity? Otol Neurotol 2012;33:591–510.1097/MAO.0b013e31824bae10CrossRefGoogle ScholarPubMed
Kuo, P, Bagwell, KA, Mongelluzzo, G, Schutt, CA, Malhotra, A, Khokhar, B et al. Semicircular canal dehiscence among idiopathic intracranial hypertension patients. Laryngoscope 2018;128:1196–9CrossRefGoogle ScholarPubMed
Brandolini, C, Modugno, GC, Pirodda, A. Dehiscence of the superior semicircular canal: a review of the literature on its possible pathogenic explanations. Eur Arch Otorhinolaryngol 2014;271:435–710.1007/s00405-013-2497-xCrossRefGoogle ScholarPubMed
Crovetto, M, Whyte, J, Rodriguez, OM, Lecumberri, I, Martinez, C, Elexpuru, J. Anatomo-radiological study of the superior semicircular canal dehiscence: radiological considerations of superior and posterior semicircular canals. Eur J Radiol 2010;76:167–7210.1016/j.ejrad.2009.05.038CrossRefGoogle ScholarPubMed
Tavassolie, TS, Penninger, RT, Zuniga, MG, Minor, LB, Carey, JP. Multislice computed tomography in the diagnosis of superior canal dehiscence: how much error, and how to minimize it? Otol Neurotol 2012;33:215–2210.1097/MAO.0b013e318241c23bCrossRefGoogle Scholar
Masaki, Y. The prevalence of superior canal dehiscence syndrome as assessed by temporal bone computed tomography imaging. Acta Otolaryngol 2011;131:258–62CrossRefGoogle ScholarPubMed
Mondina, M, Bonnard, D, Barreau, X, Darrouzet, V, Franco-Vidal, V. Anatomo-radiological study of the superior semicircular canal dehiscence of 37 cadaver temporal bones. Surg Radiol Anat 2013;35:55–910.1007/s00276-012-0992-1CrossRefGoogle ScholarPubMed
Branstetter, BF 4th, Harrigal, C, Escott, EJ, Hirsch, BE. Superior semicircular canal dehiscence: oblique reformatted CT images for diagnosis. Radiology 2006;238:938–42CrossRefGoogle ScholarPubMed
Tunkel, AE, Carey, JP, Pearl, M. Flat panel computed tomography in the diagnosis of superior semicircular canal dehiscence syndrome. Otol Neurotol 2019;40:213–17CrossRefGoogle Scholar
Cloutier, J, Belair, M, Saliba, I. Superior semicircular canal dehiscence: positive predictive value of high-resolution CT scanning. Eur Arch Otorhinolaryngol 2008;265:1455–60CrossRefGoogle ScholarPubMed
Belden, CJ, Weg, N, Minor, LB, Zinreich, SJ. CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo. Radiology 2003;226:337–43CrossRefGoogle ScholarPubMed
Browaeys, P, Larson, TL, Wong, ML, Patel, U. Can MRI replace CT in evaluating semicircular canal dehiscence? AJNR Am J Neuroradiol 2013;34:1421–7CrossRefGoogle ScholarPubMed
Beyazal Çeliker, F, Özgür, A, Çeliker, M, Beyazal, M, Turan, A, Terzi, S et al. The efficacy of magnetic resonance imaging for the diagnosis of superior semicircular canal dehiscence. J Int Adv Otol 2018;14:68–71CrossRefGoogle Scholar
Bremke, M, Luers, JC, Anagiotos, A, Gostian, AO, Dorn, F, Kabbasch, C et al. Comparison of digital volume tomography and high-resolution computed tomography in detecting superior semicircular canal dehiscence--a temporal bone study. Acta Otolaryngol 2015;135:901–6CrossRefGoogle Scholar
Kontorinis, G, Giesemann, AM, Witt, T, Goetz, F, Schwab, B. Controlling the position and the dislocation of the middle ear transducer with high-resolution computed tomography and digital volume tomography: implications for the transducers' design. Eur Arch Otorhinolaryngol 2012;269:1103–10CrossRefGoogle ScholarPubMed
Bremke, M, Luers, J, Stenner, M, Bovenschulte, H, Dorn, F, Unkel, C et al. Radiologic examinations in human temporal bone specimens using digital volume tomography and high-resolution computed tomography after implantation of middle ear prosthesis and cochlear implant electrode array. Otol Neurotol 2013;34:1321–8CrossRefGoogle ScholarPubMed
Zuniga, MG, Janky, KL, Nguyen, KD, Welgampola, MS, Carey, JP. Ocular versus cervical VEMPs in the diagnosis of superior semicircular canal dehiscence syndrome. Otol Neurotol 2013;34:121–6CrossRefGoogle Scholar
Colebatch, JG, Halmagyi, GM, Skuse, NF. Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 1994;57:190–7CrossRefGoogle ScholarPubMed
Welgampola, MS, Myrie, OA, Minor, LB, Carey, JP. Vestibular-evoked myogenic potential thresholds normalize on plugging superior canal dehiscence. Neurology 2008;70:464–72CrossRefGoogle ScholarPubMed
Streubel, SO, Cremer, PD, Carey, JP, Weg, N, Minor, LB. Vestibular-evoked myogenic potentials in the diagnosis of superior canal dehiscence syndrome. Acta Otolaryngol Suppl 2001;545:41–9CrossRefGoogle Scholar
Chien, W, Ravicz, ME, Rosowski, JJ, Merchant, SN. Measurements of human middle-and inner-ear mechanics with dehiscence of the superior semicircular canal. Otol Neurotol 2007;28:250–7CrossRefGoogle ScholarPubMed
Kantner, C, Gürkov, R. Characteristics and clinical applications of ocular vestibular evoked myogenic potentials. Hear Res 2012;294:55–63CrossRefGoogle ScholarPubMed
Rosengren, SM, McAngus Todd, NP, Colebatch, JG. Vestibular-evoked extraocular potentials produced by stimulation with bone-conducted sound. Clin Neurophysiol 2005;116:1938–48CrossRefGoogle ScholarPubMed
Iwasaki, S, McGarvie, LA, Halmagyi, GM, Burgess, AM, Kim, J, Colebatch, JG et al. Head taps evoke a crossed vestibulo-ocular reflex. Neurology 2007;68:1227–910.1212/01.wnl.0000259064.80564.21CrossRefGoogle ScholarPubMed
Manzari, L, Tedesco, A, Burgess, AM, Curthoys, IS. Ocular vestibular-evoked myogenic potentials to bone-conducted vibration in superior vestibular neuritis show utricular function. Otolaryngol Head Neck Surg 2010;143:274–80CrossRefGoogle ScholarPubMed
Zuniga, MG, Davalos-Bichara, M, Schubert, MC, Carey, JP, Janky, KL. Optimizing ocular vestibular evoked myogenic potential testing for superior semicircular canal dehiscence syndrome: electrode placement. Audiol Neurootol 2014;19:239–47CrossRefGoogle ScholarPubMed
Thabet, EM. Ocular vestibular evoked myogenic potentials n10 response in autism spectrum disorders children with auditory hypersensitivity: an indicator of semicircular canal dehiscence. Eur Arch Otorhinolaryngol 2014;271:1283–810.1007/s00405-013-2736-1CrossRefGoogle ScholarPubMed
Noij, KS, Herrmann, BS, Guinan, JJ Jr, Rauch, SD. Toward optimizing cVEMP: 2,000-Hz tone bursts improve the detection of superior canal dehiscence. Audiol Neurootol 2018;23:335–44CrossRefGoogle ScholarPubMed
Brantberg, K, Bergenius, J, Tribukait, A. Vestibular-evoked myogenic potentials in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol 1999;119:633–40Google ScholarPubMed
Vlastarakos, PV, Proikas, K, Tavoulari, E, Kikidis, D, Maragoudakis, P, Nikolopoulos, TP. Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies. Eur Arch Otorhinolaryngol 2009;266:177–86CrossRefGoogle ScholarPubMed
Beyea, JA, Agrawal, SK, Parnes, LS. Transmastoid semicircular canal occlusion: a safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence. Laryngoscope 2012;122:1862–6CrossRefGoogle ScholarPubMed
Ward, BK, Agrawal, Y, Nguyen, E, Della Santina, CC, Limb, CJ, Francis, HW et al. Hearing outcomes after surgical plugging of the superior semicircular canal by a middle cranial fossa approach. Otol Neurotol 2012;33:1386–9110.1097/MAO.0b013e318268d20dCrossRefGoogle ScholarPubMed
Gioacchini, FM, Alicandri-Ciufelli, M, Kaleci, S, Scarpa, A, Cassandro, E, Re, M. Outcomes and complications in superior semicircular canal dehiscence surgery: a systematic review. Laryngoscope 2016;126:1218–24CrossRefGoogle ScholarPubMed
Nguyen, T, Lagman, C, Sheppard, JP, Romiyo, P, Duong, C, Prashant, GN et al. Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach. Acta Neurochir (Wien) 2018;160:1219–2410.1007/s00701-017-3346-2CrossRefGoogle ScholarPubMed
Nikkar-Esfahani, A, Banerjee, A. Occlusion of the round window: a novel way to treat hyperacusis symptoms in superior semicircular canal dehiscence. J Laryngol Otol 2013;127:705–7CrossRefGoogle ScholarPubMed
Succar, EF, Manickam, PV, Wing, S, Walter, J, Greene, JS, Azeredo, WJ. Round window plugging in the treatment of superior semicircular canal dehiscence. Laryngoscope 2018;128:1445–5210.1002/lary.26899CrossRefGoogle ScholarPubMed
Ahmed, W, Rajagopal, R, Lloyd, G. Systematic review of round window operations for the treatment of superior semicircular canal dehiscence. J Int Adv Otol 2019;15:209–1410.5152/iao.2019.6550CrossRefGoogle ScholarPubMed