Evaluation of superior semicircular canal dehiscence in patients with vertigo and tinnitus

Yıl 2009, Cilt: 19 Sayı: 2, 77 - 81, 12.03.2009

Çağlar Çallı Ercan Pınar Semih Öncel Nezahat Erdoğan Kerim Sadullahoğlu

Öz

Objectives: The aim of the study was to investigate the presence of superior semicircular canal dehiscence SSC in patients with unknown etilogy of vertigo/tinnitus. Patients and Methods: This study was performed prospectively between December 2007 and March 2008. Fifty five patients 23 males, 32 females; mean age 44.5 years; range 36 to 74 years with complaints of vertigo and/or tinnitus, of which we couldn’t establish the etiologies, were included in the study. Control group was consisted of 15 patients who didn’t have complaints of vertigo and/or tinnitus. A high resolution temporal bone computed tomograpy CT scan 1 mm slice thickness was performed in all study groups patients and controls . Results: Thirty nine subjects 72% had normal odiometric findings. Mild conductive hearing loss was present in 12 22% subjects. Two 3% of the patients had moderate conductive hearing loss and the other two subjects 3% had mixed type hearing loss. High resolution temporal bone CT scan revealed that 35 65% subjects had dehissence around SSC otic capsule whereas 20 35% remaining patients yielded no dehissence. Twenty one of 35 patients 60% with dehissence at SSC had minimum defect and 14 patients 40% had significant defect. Bilateral defect was present in nine 64% of 14 patients with significant defect but none of the subjects with minimum defect showed bilateral involvement. None of the control subjects exhibited SSC dehissence with CT imaging. Conclusion: Semicircular canal dehissence was found in 65% of the patients with unknown etiology of the vertigo and tinnitus. Physicians should evaluate the SSC dehissence in patients with vertigo and tinnitus as an etiologic factor.

Anahtar Kelimeler

Superior semicircular canal dehissence, tinnitus, vertigo

Vertigo ve tinnituslu hastalarda süperior semisirküler kanal dehissansının araştırılması

Öz

Amaç: Etyolojisini saptayamadığımız vertigo ve/veya tinnitus yakınması ile başvuran hastalarda süperior semisirküler kanal SSK dehissansı varlığı araştırıldı.Hastalar ve Yöntemler: İleriye yönelik olarak Aralık 2007-Mart 2008 yılları içerisinde polikliniğimize vertigo ve/veya tinnitus yakınması ile başvuran ve etyolojisini saptayamadığımız 55 hasta 23 erkek, 32 kadın; ort. yaş 44.5 yıl; dağılım 36-74 yıl çalışmaya alındı. Vertigo ve/veya tinnitus yakınması olmayan herhangi bir nedenle polikliniğimize başvuran 15 hasta kontrol grubu olarak belirlendi. Çalışma ve kontrol grubu hastalarında temporal kemik, koronal planda yüksek rezolüsyonlu 1 mm kesit kalınlığı bilgisayarlı tomografi BT ile değerlendirildi.Bulgular: Çalışmamızdaki hastaların 39’unda %72 odyometrik bulgular normal, 12’sinde %22 hafif derecede iletim tipi işitme kaybı, ikisinde %3 orta derecede iletim tipi işitme kaybı ve ikisinde %3 mikst tip işitme kaybı vardı. Temporal kemik BT bulgularına göre hastaların 35’inde %65 SSK çevresi otik kapsülde dehissans saptandı. Yirmi hastada %35 dehissans izlenmedi. Süperior semisirküler kanal dehissansı olan hastaların 21’inde %60 minimal defekt, 14’ünde %40 belirgin defekt vardı. Minimal defektli hastalarda iki taraflı patoloji izlenmezken, belirgin defekti olan 14 hastanın dokuzunda %64 iki taraflı defekt saptandı. Kontrol grubunun BT görüntülerinde SSK dehissansına rastlanmadı.Sonuç: Etyolojisi bilinmeyen vertigo ve/veya tinnituslu hastalarda %65 oranında SSK dehissansı saptandı. Klinisyenler vertigo ve tinnitus olgularında SSK dehissansını etyolojik bir faktör olarak araştırmalıdır

Anahtar Kelimeler

Süperior semisirküler kanal dehissansı, tinnitus, vertigo

Kaynakça

• 1. Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and/ or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 1998;124:249-58.
• 2. Brantberg K, Bergenius J, Mendel L, Witt H, Tribukait A, Ygge J. Symptoms, findings and treatment in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol 2001;121:68-75.
• 3. Kwee HL. The occurrence of the Tullio phenomenon in congenitally deaf children. J Laryngol Otol 1976; 90:501-7.
• 4. Hillman TA, Kertesz TR, Hadley K, Shelton C. Reversible peripheral vestibulopathy: the treatment of superior canal dehiscence. Otolaryngol Head Neck Surg 2006;134:431-6.
• 5. 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;126:137-47.
• 6. Minor LB, Cremer PD, Carey JP, Della Santina CC, Streubel SO, Weg N. Symptoms and signs in superior canal dehiscence syndrome. Ann N Y Acad Sci 2001;942:259-73.
• 7. Hirvonen TP, Carey JP, Liang CJ, Minor LB. Superior canal dehiscence: mechanisms of pressure sensitivity in a chinchilla model. Arch Otolaryngol Head Neck Surg 2001;127:1331-6.
• 8. Cremer PD, Minor LB, Carey JP, Della Santina CC. Eye movements in patients with superior canal dehiscence syndrome align with the abnormal canal. Neurology 2000;55:1833-41.
• 9. 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;226:337-43.
• 10. Minor LB. Superior canal dehiscence syndrome. Am J Otol 2000;21:9-19.
• 11. Williamson RA, Vrabec JT, Coker NJ, Sandlin M. Coronal computed tomography prevalence of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 2003;129:481-9.
• 12. Brantberg K, Ishiyama A, Baloh RW. Drop attacks secondary to superior canal dehiscence syndrome. Neurology 2005;64:2126-8.
• 13. Minor LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 2005; 115:1717- 27.
• 14. Mikulec AA, McKenna MJ, Ramsey MJ, Rosowski JJ, Herrmann BS, Rauch SD, et al. Superior semicircular canal dehiscence presenting as conductive hearing loss without vertigo. Otol Neurotol 2004;25:121-9.
• 15. 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;25:323-32.
• 16. Minor LB. Labyrinthine fistulae: pathobiology and management. Curr Opin Otolaryngol Head Neck Surg 2003;11:340-6.