背景:上半规管裂开综合征(SCDS)是一种可引起不稳定的临床综合征,眩晕,丰满度,耳鸣,尸检,听力损失(HL),图利奥现象,或者亨内伯特的标志。历史上,手术一直是文献报道的主要治疗方法,尽管也可能会提出一些药物治疗。本研究旨在全面表征一系列患者的SCDS,听觉,和前庭透视,并通过比较其结果和演变,探索传统手术治疗的医学替代方案。
方法:在三级护理中心设计了一项回顾性观察性研究。评估的前庭听力测试包括纯音测听法(PTA),VEMPs,视频头脉冲测试(vHIT),和CT成像。在长达6个月的随访期内,评估了7种主要症状的改善情况,以验证所提出的治疗方法的疗效。
结果:71名SCDS患者,平均年龄51.20±12.22岁。在我们的样本中发现的最常见症状是31例患者(43.66%)不稳定,其次是29名受试者的听觉饱满度或耳鸣(40.85%)。36例(43.66%)患者接受了治疗,其中28例(77.78%)症状减轻。五名患者接受了手术修复,都表现出症状改善。观察到统计学上的显着改善(p<0.05),特别是手术治疗和乙酰唑胺,在症状和客观测试中,如纯音测听和VEMPs。
结论:SCDS显示出与其他耳囊开裂的显著相似性。完成诊断必须进行VEMPs和CT扫描,通常伴随着可清晰识别的临床标准。手术治疗SCDS是有效的,安全,没有并发症。然而,在症状轻度至中度的情况下,用利尿剂如乙酰唑胺治疗这种情况已显示出有希望的结果。
BACKGROUND: Superior semicircular canal dehiscence syndrome (SCDS) is a clinical syndrome that can cause instability, vertigo, fullness, tinnitus, autophony, hearing loss (HL), Tullio phenomenon, or Hennebert\'s sign. Historically, surgery has been the primary treatment reported in the literature, although some medical treatments may also be proposed. This study aims to comprehensively characterize SCDS in a large series of patients from clinical, auditory, and vestibular perspectives, and explore medical alternatives to conventional surgical treatments by comparing their results and evolution.
METHODS: A retrospective observational study was designed in a tertiary care center. Audiovestibular tests evaluated included pure-tone audiometry (PTA), VEMPs, video head impulse test (vHIT), and CT imaging. Improvement was assessed over a follow-up period of up to 6 months for seven cardinal symptoms to verify the efficacy of the proposed treatments.
RESULTS: 71 subjects with SCDS and a mean age of 51.20 ± 12.22 years were included in the study. The most common symptom found in our sample was instability in 31 patients (43.66%), followed by aural fullness or tinnitus in 29 subjects (40.85%). 36 patients (43.66%) received medical treatment, with 28 of them (77.78%) showing symptom reduction. Surgical repair was indicated in five patients, with all showing symptom improvement. Statistically significant improvement (p < 0.05) was observed, particularly with surgical treatment and acetazolamide, in both symptoms and objective tests such as pure-tone audiometry and VEMPs.
CONCLUSIONS: SCDS shows significant similarities with other otic capsule dehiscences. It is essential to perform VEMPs and CT scans to complete the diagnosis, which is usually accompanied by clearly recognizable clinical criteria. Surgery for SCDS is effective, safe, and without complications. However, in cases where symptoms are mild to moderate, addressing this condition with medical treatment using diuretics such as acetazolamide has shown promising results.