Superior semicircular canal dehiscence presenting as postpartum vertigo

Karen F Watters, John J Rosowski, Todd Sauter, Daniel J Lee
Otology & Neurotology 2006, 27 (6): 756-68

OBJECTIVE: To describe the clinical and diagnostic features of superior semicircular canal dehiscence (SSCD) in patients with postpartum vertigo.

STUDY DESIGN: Retrospective review, meta-analysis.

SETTING: Tertiary neurotologic and audiologic center.

PATIENTS: Two women who presented with a history of acute postpartum vertigo and SSCD confirmed on high-resolution computed tomography (CT) were included. Our meta-analysis of the surgical SSCD literature comprised a total of 43 patients.

INTERVENTION: Patients with postpartum vertigo and SSCD underwent a complete medical evaluation, audiometric testing, CT imaging, magnetic resonance imaging studies, vestibular evoked myogenic potential testing, and laser Doppler vibrometer testing. Case 2 was managed with a middle fossa craniotomy and SSCD repair.

RESULTS: The first patient presented with normal hearing and aural fullness, autophony, and sound sensitivity of the left ear. A 1-mm left-sided SSCD was seen on CT imaging. She is being managed conservatively. The second patient had left-sided conductive hearing loss with sound and pressure sensitivity. The contralateral ear was congenitally deaf. CT imaging revealed a 4-mm left-sided SSCD. Because of her disabling symptoms, the patient underwent a middle fossa craniotomy and superior canal plugging. Her vestibular symptoms resolved with improvement in hearing. Vestibular evoked myogenic potential and laser Doppler vibrometer testing in both cases were consistent with SSCD.

CONCLUSION: This is the first description of patients with SSCD presenting after childbirth and should be included in the differential diagnosis of acute postpartum vertigo or disequilibrium. SSCD plugging can provide a stable repair with resolution of symptoms, reversal of diagnostic indicators, and hearing improvement.

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