Diagnostic Yield of Patients Undergoing Evaluation of Possible Superior Canal Dehiscence

Ryan A Bartholomew; Marta M Williams; Brigette L Wang; Alejandro Garcia; Daniel J Lee; C Eduardo Corrales; Neil Bhattacharyya

doi:10.1002/lary.31472

Diagnostic Yield of Patients Undergoing Evaluation of Possible Superior Canal Dehiscence

Laryngoscope. 2024 Apr 30. doi: 10.1002/lary.31472. Online ahead of print.

Authors

Ryan A Bartholomew^{1

2}, Marta M Williams¹, Brigette L Wang¹, Alejandro Garcia¹, Daniel J Lee¹, C Eduardo Corrales^{1

2}, Neil Bhattacharyya¹

Affiliations

¹ Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.
² Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.

PMID: 38686832
DOI: 10.1002/lary.31472

Abstract

Objective: To characterize the diagnostic yield of patients undergoing evaluation for superior canal dehiscence syndrome (SCDS), and identify alternative conditions diagnosed in patients suspected of, but not ultimately diagnosed with, SCDS.

Methods: Diagnostically undifferentiated adult patients suspected of having SCDS were identified between 2016 and 2021 at a tertiary academic medical system. Patients were categorized by diagnostic testing, radiographic superior semicircular canal (SSC) abnormality, symptoms, evaluating clinician specialty, operative intervention, and diagnosis. Differences among groups were assessed for statistical significance.

Results: Of 1242 candidate patients, 477 met inclusion criteria-evaluation by a clinician with SCDS on their differential diagnosis prior to diagnostic imaging. The mean (SD) age was 53.0 (15.0) years and 70.6% were female. A total of 364 patients underwent subsequent diagnostic imaging, and among these, 164 (45.1%) had a radiographic SSC abnormality with 99 (27.2%) receiving a diagnosis of SCDS (two cases of "near dehiscence syndrome"). One third (33.3%) of patients with SCDS underwent operative repair. Most clinicians with the initial suspicion for SCDS were otolaryngologists (90.6%), who had greater diagnostic yield than clinicians from other specialties (22.2% vs. 6.7%, p = 0.012). Patients not diagnosed with SCDS alternatively received 21 unique diagnoses and 52.1% (138/265) were not definitively diagnosed with any condition.

Conclusions: This study characterizes the diagnostic incidence, or yield, of newly identified radiographic SSC abnormalities (45.1%) and SCDS (27.2%) among people suspected of having SCDS. Considerable overlap in presentation between SCDS and other conditions exists, and there is need for improvement in efficiently diagnosing patients with SCDS and audio-vestibular complaints in general.

Level of evidence: III Laryngoscope, 2024.

Keywords: diagnosis; incidence; near dehiscence; prevalence; superior canal dehiscence syndrome; superior semicircular canal.