Comparison of Transmastoid and Middle Fossa Approaches for Superior Canal Dehiscence Repair: A Multi-institutional Study

Otolaryngol Head Neck Surg. 2019 Jul;161(1):130-136. doi: 10.1177/0194599819835173. Epub 2019 Mar 5.


Objective: To compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates.

Study design: Multicenter retrospective comparative cohort study.

Settings: Three tertiary neurotology centers.

Subjects and methods: All adult patients undergoing repair for superior canal dehiscence between 2006 and 2017 at 3 neurotology centers were included. Demographics and otologic history collected by chart review. Imaging, audiometric data, and vestibular evoked myogenic potential measurements were also collected for analysis.

Results: A total of 68 patients (74 ears) were included in the study. Twenty-one patients underwent middle fossa craniotomy repair (mean age, 47.9 years), and 47 underwent transmastoid repair (mean age, 48.0 years). There were no significant differences in age or sex distribution between the groups. The transmastoid group experienced a significantly shorter duration of hospitalization and lower recurrence rate as compared with the middle fossa craniotomy group (3.8% vs 33%). Both groups experienced improvement in noise-induced vertigo, autophony, pulsatile tinnitus, and nonspecific vertigo. There was no significant difference among symptom resolution between groups. Additionally, there was no significant difference in audiometric outcomes between the groups.

Conclusion: Both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach.

Keywords: Tullio; clinical outcomes; middle fossa craniotomy; superior canal dehiscence; transmastoid.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Cranial Fossa, Middle / surgery*
  • Craniotomy / methods*
  • Female
  • Humans
  • Labyrinth Diseases / pathology*
  • Labyrinth Diseases / surgery*
  • Length of Stay / statistics & numerical data
  • Male
  • Mastoid / surgery*
  • Middle Aged
  • Operative Time
  • Otologic Surgical Procedures / methods*
  • Postoperative Complications / epidemiology
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Semicircular Canals / pathology*
  • Semicircular Canals / surgery*