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Email address must have at least 0 and no more than 256 characters.The value of the Email address field is not valid. Two surgical approaches have been used - superior canal resurfacing and superior canal plugging.
Middle fossa craniotomy is a safe surgical procedure and is the most common approach used to repair SCD.
If the skull base or tegmen is very low it can be difficult to safely reach the superior canal safely with a transmastoid approach to create two labyrinthotomies (as the SCD is not directly repaired) and then plug these two holes to indirectly repair the defect. Ideally, the transmastoid approach may be useful for a patient that has SCD and a skull base or tegmen that is NOT low-lying and has no other associated holes or brain herniating into the ear. This patient complained of chronic dysequilibrium and episodic dizziness, worsened with straining and loud noises. Serial audiograms before surgery showed a progressive severe sensorineural hearing loss on the left ear with a mild to moderate conductive component in the low frequencies, and present stapedial, or acoustic reflexes.
Vestibular Evoked Myogenic Potential Testing (VEMP) revealed markedly decreased thresholds in the left ear (50 to 60dB using tone burst testing), compared with the right (80 to 90 dB).
ABOVE: Temporal bone CT scans of the right (A,C) and left (B,D) superior semicircular canals. This patient was followed conservatively for several months with vestibular suppressants but her symptoms worsened.
A 4-5mm widely dehiscent SSC was encountered intraoperatively and was plugged with bone wax. Within about one month following her surgery, she noticed a complete resolution of her dizziness with improvement in her conductive hearing loss. Audiogram, right: Postop hearing test showing closure of her air-bone gap following SCD plugging. Below: 3-D reconstruction, lateral skull CT, showing the approximate size and shape of the middle fossa craniotomy needed to expose and repair a left-sided SCD. Photo 1: middle fossa craniotomy performed, centered over the external auditory meatus, approximately 4 x 5cm. Photo 3: bone paste, harvested while turning the middle fossa craniotomy bone flap, is used to resurface the plugged superior semicircular canal. Photo 5: split calverial bone graft followed by a second piece of fascia is used to resurface the remaining skull base floor. Not shown: once the skull base reconstruction is complete, a mini-titanium plate cranioplasty is performed, followed by multiple layer tissue and skin closure.
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Although theoretically less traumatic to the membraneous labyrinth, resurfacing techniques have led to recurrent symptoms secondary to shifting or resorption of the bone and fascia reconstruction.
In some cases, the SCD may be located along the SIDE of the canal (Case #4) and not on the TOP, as seen in most classic cases of SCDS.
These were high resolution CT scans reformatted to the planes of Stenver (A,B) and Poschel (C,D).
A big concern was that she was deaf in the right ear since birth, and so there was great reluctance to offer a left sided SCD repair. Because the surrounding tegmen (skull base) is often very thin or also dehiscence, a bone graft was used to reconstruct the floor around and on top of the plugged canal.
The tegmen represents the floor of the middle fossa, which is exposed using an extradural dissection to reveal the dehiscent left superior semicircular canal. We focus on assisting organizations and individuals dramatically improve their abilities and outcomes.
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The 12 band digital sound processing focuses on voices while simultaneously reducing background noise. Plugging with bone wax, bone paste, or fascia has been more commonly used to create a stable seal of the dehiscent superior semicircular canal. The craniotomy approach is ideal to 1) visual the SCD directly and 2) repair the tegmen defect(s) directly using bone and fascia.
If the defect is located on the side of the canal away from the surgeon (posterior-medial), the SCD may be more difficult to visualize using a craniotomy approach. She notes an extremely violent episode of vertigo, in the vertical plane, during child birth. A very thin, but intact bony covering is see over the right superior semicircular canal (A,C) compared with a dehiscent left superior semicircular canal (B,D). However she could no longer care for her young children and was unable to function normally, and so after careful counseling, she elected to proceed with a surgical repair of her left SCD via a middle fossa craniotomy approach.
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We have already discussed the need to clean your ears, and that ear wax should not be eliminated entirely.
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We rely on its viscous nature to trap foreign particles and keep them from damaging our ears.

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10.10.2015 admin

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