TY - JOUR
T1 - Vestibular hypofunction in the initial postoperative period after surgical treatment of superior semicircular canal dehiscence
AU - Agrawal, Yuri
AU - Migliaccio, Americo A.
AU - Minor, Lloyd B.
AU - Carey, John P.
PY - 2009/6/1
Y1 - 2009/6/1
N2 - OBJECTIVES: 1) Determine the prevalence of vestibular hypofunction in the immediate postoperative period after surgical treatment of superior semicircular canal dehiscence syndrome. 2) Evaluate whether dehiscence length is associated with risk of postoperative vestibular hypofunction. 3) Compare the prevalences of immediate and late postoperative vestibular hypofunction. STUDY DESIGN: Clinical review. SETTING: Tertiary referral center. PATIENTS: Subjects with superior canal dehiscence syndrome (n = 42) based on history, physiologic testing, and computed tomography findings, who underwent middle fossa craniotomy and superior canal dehiscence plugging. INTERVENTION: Dehiscence length was measured intraoperatively. Bedside horizontal head thrust testing (hHTT) was administered between postoperative days 1 to 7 to diagnose immediate postoperative vestibular hypofunction. Both hHTT and quantitative vestibulo-ocular reflex testing were administered 6 to 29 weeks postoperatively to detect late vestibular hypofunction. MAIN OUTCOME MEASURES: Dehiscence length and hypofunction in response to hHTT. RESULTS: Thirty-eight percent of the subjects (95% confidence interval, 25-54) had hypofunction in response to hHTT within 1 week after surgery. Mean dehiscence lengths were 4.9 (range, 2.0-10.5 mm) and 3.4 mm (range, 1.0-5.5 mm) in subjects with and without postoperative hypofunction, respectively (p = 0.0018). Each 1-mm increase in dehiscence length increased the odds of immediate postoperative hypofunction 2.6-fold (95% confidence interval, 1.3-5.1). The prevalence of vestibular hypofunction was significantly higher in the early compared with the late postoperative period. CONCLUSION: Immediate postoperative vestibular hypofunction is common, particularly with larger dehiscences. This hypofunction may typically resolve, given that the prevalence of vestibular hypofunction 6 weeks postoperatively is low. Possible mechanisms include intraoperative loss of perilymph, which may be more likely with larger dehiscences.
AB - OBJECTIVES: 1) Determine the prevalence of vestibular hypofunction in the immediate postoperative period after surgical treatment of superior semicircular canal dehiscence syndrome. 2) Evaluate whether dehiscence length is associated with risk of postoperative vestibular hypofunction. 3) Compare the prevalences of immediate and late postoperative vestibular hypofunction. STUDY DESIGN: Clinical review. SETTING: Tertiary referral center. PATIENTS: Subjects with superior canal dehiscence syndrome (n = 42) based on history, physiologic testing, and computed tomography findings, who underwent middle fossa craniotomy and superior canal dehiscence plugging. INTERVENTION: Dehiscence length was measured intraoperatively. Bedside horizontal head thrust testing (hHTT) was administered between postoperative days 1 to 7 to diagnose immediate postoperative vestibular hypofunction. Both hHTT and quantitative vestibulo-ocular reflex testing were administered 6 to 29 weeks postoperatively to detect late vestibular hypofunction. MAIN OUTCOME MEASURES: Dehiscence length and hypofunction in response to hHTT. RESULTS: Thirty-eight percent of the subjects (95% confidence interval, 25-54) had hypofunction in response to hHTT within 1 week after surgery. Mean dehiscence lengths were 4.9 (range, 2.0-10.5 mm) and 3.4 mm (range, 1.0-5.5 mm) in subjects with and without postoperative hypofunction, respectively (p = 0.0018). Each 1-mm increase in dehiscence length increased the odds of immediate postoperative hypofunction 2.6-fold (95% confidence interval, 1.3-5.1). The prevalence of vestibular hypofunction was significantly higher in the early compared with the late postoperative period. CONCLUSION: Immediate postoperative vestibular hypofunction is common, particularly with larger dehiscences. This hypofunction may typically resolve, given that the prevalence of vestibular hypofunction 6 weeks postoperatively is low. Possible mechanisms include intraoperative loss of perilymph, which may be more likely with larger dehiscences.
KW - Semicircular canal
KW - Vertigo
KW - Vestibulo-ocular reflex
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U2 - 10.1097/MAO.0b013e3181a32d69
DO - 10.1097/MAO.0b013e3181a32d69
M3 - Article
C2 - 19339908
AN - SCOPUS:68249110952
SN - 1531-7129
VL - 30
SP - 502
EP - 506
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 4
ER -