Silverstein Institute, Ear Research Foundation, Sarasota, FL.
Michigan Ear Institute, Farmington Hills, MI.
Am J Otolaryngol. 2014 May-Jun;35(3):286-93. doi: 10.1016/j.amjoto.2014.02.016. Epub 2014 Mar 5.
To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD).
Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity.
Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery.
RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.
评估圆窗（RW）组织加固在处理上半规管裂（SSCD）中的效果。
本研究纳入了 22 例经临床、影像学和/或检查确诊为 SSCD 的患者。四家机构的六名外科医生对接受 RW 组织加固或完全 RW 闭塞治疗的有症状上半规管裂患者进行了多中心图表回顾。采用经耳道入路用各种类型的组织加固 RW。患者完成了一项新的术后调查，对术前和术后症状严重程度进行分级。
分析显示，除了 19 名接受 RW 加固的患者听力损失外，所有症状均有统计学意义上的改善。相比之下，3 名接受 RW 窝封闭替代治疗的患者中有 2 名出现症状恶化，需要再次手术。
RW 组织加固可能减轻 SSCD 相关症状。加固技术可能通过减少半规管裂引起的“第三窗口”效应使 SSCD 患者受益。与中颅窝或经乳突道闭塞相比，RW 加固的风险较低，因此可能成为治疗顽固性 SSCD 的初始适宜手术。相比之下，不建议完全 RW 闭塞。
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