Video Head Impulse Test Demonstrates a Residual Function after Plugging of Dehiscent Superior Semicircular Canal

Abstract

ObjectivePlugging a symptomatic dehiscent superior semicircular canal (SSCC) often leads to a nonfunctional postoperative canal. However, in some instances, a residual function has been described. This study attempts to describe what factors may lead to such residual function.Study designRetrospective study.SettingTertiary referral center.PatientsThirty-five patients with confirmed SSCC dehiscence.InterventionVideo head impulse test was conducted pre- and postoperatively to assess any difference in the function of the SSCC.Main Outcome measuresMean gain and pathological saccades were recorded according to well-established thresholds along with dehiscence length and location to evaluate any associations to residual canal function.ResultsWhen comparing preoperative to postoperative SSCC abnormal gains, a significant increase was observed after plugging (p= 0.023). This also held true when abnormal gain and pathologic saccades were taken together (p< 0.001). Interestingly, 55.3% of patients were observed to remain with a residual SSCC function 4 months postoperatively even with a clinical improvement. Of these, 47.6% had normal gain with pathologic saccades, 38.1% had an abnormal gain without pathologic saccades, and 14.3% had normal gain without pathologic saccades (normal function). Preoperatively, SSCC abnormal gain was associated with a larger dehiscence length mean (p= 0.002). Anterosuperior located dehiscences were also associated with a larger dehiscence length mean (p= 0.037). A residual SSCC function after plugging was associated with a shorter dehiscence length regardless of location (p= 0.058).ConclusionDehiscence length and location may be useful in predicting disease symptomatology preoperatively and canals function recovery after plugging. These factors could be used as indicators for preoperative counseling and long-term management.