Lorente-Piera Joan, Prieto-Matos Carlos, Fernández Nicolás Pérez, Blanco-Pareja Melissa, Gil Diego Calavia, Manrique Manuel, Manrique-Huarte Raquel
Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España.
Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Madrid, España.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):103-112. doi: 10.1007/s00405-024-08896-3. Epub 2024 Aug 23.
Superior semicircular canal dehiscence syndrome (SCDS) is a clinical syndrome that can cause instability, vertigo, fullness, tinnitus, autophony, hearing loss (HL), Tullio phenomenon, or Hennebert's sign. Historically, surgery has been the primary treatment reported in the literature, although some medical treatments may also be proposed. This study aims to comprehensively characterize SCDS in a large series of patients from clinical, auditory, and vestibular perspectives, and explore medical alternatives to conventional surgical treatments by comparing their results and evolution.
A retrospective observational study was designed in a tertiary care center. Audiovestibular tests evaluated included pure-tone audiometry (PTA), VEMPs, video head impulse test (vHIT), and CT imaging. Improvement was assessed over a follow-up period of up to 6 months for seven cardinal symptoms to verify the efficacy of the proposed treatments.
71 subjects with SCDS and a mean age of 51.20 ± 12.22 years were included in the study. The most common symptom found in our sample was instability in 31 patients (43.66%), followed by aural fullness or tinnitus in 29 subjects (40.85%). 36 patients (43.66%) received medical treatment, with 28 of them (77.78%) showing symptom reduction. Surgical repair was indicated in five patients, with all showing symptom improvement. Statistically significant improvement (p < 0.05) was observed, particularly with surgical treatment and acetazolamide, in both symptoms and objective tests such as pure-tone audiometry and VEMPs.
SCDS shows significant similarities with other otic capsule dehiscences. It is essential to perform VEMPs and CT scans to complete the diagnosis, which is usually accompanied by clearly recognizable clinical criteria. Surgery for SCDS is effective, safe, and without complications. However, in cases where symptoms are mild to moderate, addressing this condition with medical treatment using diuretics such as acetazolamide has shown promising results.
上半规管裂综合征（SCDS）是一种临床综合征，可导致不稳感、眩晕、耳闷、耳鸣、自听过强、听力损失（HL）、图利奥现象或亨内贝尔征。从历史上看，手术一直是文献中报道的主要治疗方法，不过也可能会提出一些药物治疗方法。本研究旨在从临床、听觉和前庭角度全面描述一大组患者的SCDS情况，并通过比较其结果和病情发展来探索传统手术治疗的替代药物治疗方法。
在一家三级医疗中心设计了一项回顾性观察研究。评估的听前庭测试包括纯音听力测定（PTA）、视频眼震肌源性电位（VEMPs）、视频头脉冲试验（vHIT）和CT成像。在长达6个月的随访期内评估七种主要症状的改善情况，以验证所提议治疗方法的疗效。
本研究纳入了71例SCDS患者，平均年龄为51.20±12.22岁。我们样本中最常见的症状是31例患者（43.66%）出现不稳感，其次是29例受试者（40.85%）出现耳闷或耳鸣。36例患者（43.66%）接受了药物治疗，其中28例（77.78%）症状减轻。5例患者接受了手术修复，所有患者症状均有改善。在症状以及纯音听力测定和VEMPs等客观测试中，观察到有统计学意义的改善（p< 0.05），特别是手术治疗和乙酰唑胺治疗。
SCDS与其他耳囊裂有显著相似之处。进行VEMPs和CT扫描以完成诊断至关重要，诊断通常伴有明确可辨的临床标准。SCDS手术有效、安全且无并发症。然而，在症状为轻至中度的情况下，使用乙酰唑胺等利尿剂进行药物治疗已显示出有希望的结果。
