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 3

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

5. 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

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

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

8. Tullio Phenomenon

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

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

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

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

13. CT
Special cuts
Stenver’s:
Ortogonal 13 13

14. CT
Stenver’s:
Ortogonal 14 14

15. CT
Stenver’s:
Orthogonal 15 15

16. CT
Stenver’s:
Orthogonal 16 16

17. CT
Stenver’s:
Orthogonal 17 17

18. CT
Posch’s: Parallel 18 18

19. CT
Posch’s: Parallel 19 19

20. CT
Posch’s: Parallel 20 20

21. CT
Posch’s: Parallel 21 21

22. CT
Posch’s: Parallel 22 22

23. CT
Posch’s: Parallel 23 23

24. CT
Posch’s: Parallel 24 24

25. 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 ( ). 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

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 ( ). 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

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 ( ). 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

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 ( ). 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

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 ( ). 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

30. 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 ( ). 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

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

32. Thank You