Superior semicircular canal dehiscence in East Asian women with osteoporosis
Superior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis.
A retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with Pöschl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans.
Of the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the Pöschl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < −2.5 in the axial spine, while another had osteopenia with a T-score of −2.3 in the left femur.
We describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.
- Minor LB, Solomon D, Zinreich JS, Zee DS: Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 1998, 124:249-258.
- Belden CJ, Weg N, Minor LB, Zinreich SJ: CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo. Radiology 2003, 226:337-343. CrossRef
- Yuen H-W, Boeddinghaus R, Eikelboom RH, Atlas MD: The relationship between the air-bone gap and the size of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 2009, 141:689-694. CrossRef
- Carey JP, Minor LB, Nager GT: Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg 2000, 126:137-147.
- Zhou G, Gopen Q, Poe DS: Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker. Otol Neurotol 2007, 28:920-926. CrossRef
- Pfammatter A, Darrouzet V, Gärtner M, Somers T, Van Dinther J, Trabalzini F, Ayache D, Linder T: A superior semicircular canal dehiscence syndrome multicenter study: is there an association between size and symptoms? Otol Neurotol 2010, 31:447-454. CrossRef
- Aw ST, Todd MJ, Aw GE, Magnussen JS, Curthoys IS, Halmagyi GM: Click-evoked vestibulo-ocular reflex: Stimulus-response properties in superior canal dehiscence. Neurology 2006, 11:1079-1087. CrossRef
- Welgampola MS, Myrie OA, Minor LB, Carey JP: Vestibular-evoked myogenic potential thresholds normalize on plugging superior canal dehiscence. Neurology 2008, 70:464-472. CrossRef
- Rosengren SM, Aw ST, Halmagyi GM, McAngus Todd NP, Colebatch JG: Ocular vestibular evoked myogenic potentials in superior canal dehiscence. J Neurol Neurosurg Psychiatry 2008, 79:559-568. CrossRef
- Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM: Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 2005, 20:185-194. CrossRef
- Nadgir RN, Ozonoff A, Devaiah AK, Halderman AA, Sakai O: Superior semicircular canal dehiscence: congenital or acquired condition. AJNR Am J Neuroradiol 2011, 32:947-949. CrossRef
- Crovetto M, Whyte J, Rodriguez OM, Lecumberri I, Martinez C, Eléxpuru J: Anatomo-radiological study of the superior semicircular canal dehiscence: Radiological considerations of superior and posterior semicircular canals. Eur J Radiol 2010, 76:167-172. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6815/12/8/prepub
- Superior semicircular canal dehiscence in East Asian women with osteoporosis
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Ear, Nose and Throat Disorders
- Online Date
- July 2012
- Online ISSN
- BioMed Central
- Additional Links
- Superior semicircular canal
- Canal dehiscence
- Author Affiliations
- 1. South Cove Community Health Center, Boston, MA, USA
- 2. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 3. Section of Neuroradiology/Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA