University of Central Florida (UCF) College of Medicine, Orlando, FL, USA.
Advent Health, Central Florida, Celebration, FL, USA.
Ear Nose Throat J. 2021 Dec;100(10):NP444-NP453. doi: 10.1177/0145561320927941. Epub 2020 May 21.
(1) To determine how otologic/neurotologic surgeons counsel patients with superior semicircular canal dehiscence (SSCD). (2) To understand the plethora of presenting symptoms associated with SSCD and appropriate management. (3) To suggest appropriate management; oftentimes avoiding surgery.
This was a survey study of both community and academic physicians. A 23-question survey was distributed to all members of the American Neurotological (ANS) and American Otologic Societies (AOS) via email in the Fall of 2018. A total of 54 responses were received from a possible pool of 279 for a response rate of 19.4%. Inferences were made about the population through sample proportions and confidence intervals.
All respondents use computed tomography (CT) in diagnosing SSCD and 11.1% use CT exclusively. Cervical vestibular evoked myogenic potential (VEMP; 77.8%) are used more often than ocular VEMPs (38.9%). Magnetic resonance imaging (7.4%) is used infrequently; 96.3% of surgeons surveyed have seen patients with SSCD on imaging that are asymptomatic. Following surgical treatment, respondents reported balance issues and mild-to-moderate high-frequency sensorineural hearing loss (88.4%); 32.6% reported that the majority (>50%) of their patients needed further intervention after surgery, typically aggressive vestibular rehabilitation.
There is a discrepancy in the systematic approach to SSCD between both the surgeons and the published literature. Patients with SSCD on ultra-high-resolution CT may have myriad symptoms while others are asymptomatic, and surgery may lead to additional complications. We will present a methodical recommendation to assist in the management of patients with SSCD depending upon their symptoms. This may improve patient selection, counseling, and outcomes.
（1）确定耳神经外科医生如何向伴有上半规管裂（SSCD）的患者提供咨询。（2）了解与 SSCD 相关的大量临床表现和适当的治疗方法。（3）提出适当的治疗建议；通常避免手术。
这是一项针对社区和学术医生的调查研究。2018 年秋季，通过电子邮件向美国神经耳科医师协会（ANS）和美国耳科协会（AOS）的所有成员分发了一份包含 23 个问题的调查问卷。在可能的 279 名受访者中，共收到 54 份回复，回复率为 19.4%。通过样本比例和置信区间对总体进行推断。
所有受访者均使用计算机断层扫描（CT）诊断 SSCD，11.1%的受访者仅使用 CT。颈性前庭诱发肌源性电位（VEMP；77.8%）比眼性 VEMP（38.9%）更常用。磁共振成像（MRI；7.4%）使用较少；74.4%的调查外科医生在影像学上看到过无症状的 SSCD 患者。手术后，受访者报告存在平衡问题和轻至中度高频感音神经性听力损失（88.4%）；32.6%的受访者报告说，大多数（>50%）患者在手术后需要进一步干预，通常是积极的前庭康复治疗。
外科医生和已发表的文献之间对 SSCD 的系统处理方法存在差异。超高分辨率 CT 上有 SSCD 的患者可能有多种症状，而另一些患者无症状，且手术可能会导致其他并发症。我们将提出一种系统的推荐方法，根据患者的症状来帮助管理 SSCD 患者。这可能会改善患者的选择、咨询和治疗效果。
