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Operative Management of Posterior Semicircular Canal Dehiscence from a High Jugular Bulb
Author(s) -
Gubbels Samuel P.,
Lenkowski Paul W.,
Hansen Marlan R.
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21261
Subject(s) - medicine , otorhinolaryngology , dehiscence , head and neck surgery , head and neck , general surgery , surgery
Objective: To describe the clinical evaluation and operative management of a unique case of posterior semicircular canal dehiscence due to a high jugular bulb. Methods: Retrospective case report. Results: The patient had clinical and audiometric findings consistent with semicircular canal dehiscence and imaging demonstrating erosion of the posterior semicircular canal by a high jugular bulb. Decompression of the jugular bulb with plugging and resurfacing of the eroded canal provided resolution of vestibular symptoms without significant loss of hearing. Conclusions: Dehiscence of the posterior semicircular canal can produce a spectrum of clinical findings similar to those of superior semicircular canal dehiscence syndrome. Jugular bulb decompression with plugging and resurfacing of the area of dehiscence can be performed to successfully relieve the vestibular symptoms in such cases by directly addressing the area of dehiscence. Prevalence and Clinical Findings: Dehiscence of the posterior semicircular canal from a high jugular bulb was first described radiographically in 19862. In 2003, a review of 507 temporal bone computed tomography scans from patients with inner ear symptoms found a 4.5% incidence of dehiscence of the posterior semicircular canal, over half of whom had fistulae evident on both sides and 86% of whom had vertiginous symptoms3. Recent reports have better characterized the spectrum of clinical symptoms seem in this disorder which include hearing loss (generally conductive), pulsatile tinnitus, autophony, disequilibrium, vertigo and noise or pressure induced vertigo4,5. Most of these studies have found a great deal of variability of the presence of the clinical findings, which can potentially complicate the evaluation and treatment of patients with PSCD. The patient presented herein was found to have many of the clinical findings known to characterize PSCD including pulsatile tinnitus, noise-induced vertigo and abnormal VEMP thresholds. Interestingly, this patient did not have any significant sensorineural asymmetry or conductive component to his hearing loss as has been reported in patients with PSCD. In addition, our patient had developed his symptoms within months after sustaining head trauma and it is unclear whether this event simply unmasked or accelerated the development of symptoms from a preexisting PSCD or played a more direct role in the development of PSCD in his case.