■患有上半规管骨缺损的上管裂开综合征(SCDS)的患者可表现出过多的听觉和/或前庭症状。虽然手术修复对于有明显局部化症状的患者是一个合理的选择,临床改善的程度因患者而异,对结局预测带来挑战.本研究旨在评估术前和术后症状之间的关系,并确定修复后症状持续的预测因素。
■回顾性图表回顾。
■三级神经单机构护理中心。
■主要结果是确定SCD修复后解决和持续的原发性(最麻烦的)和非原发性听力学和前庭症状的比例。次要结果包括患者的比较,已解决患者与患者之间的手术和放射学特征持续的症状。在术前和随访时,对患者进行了标准化的患者问卷调查,包括11种听觉和8种前庭症状。Patientprevs.术后调查结果,人口统计学和临床特征,手术特征,通过单变量χ2和多变量二元logistic回归分析,比较了听力测量数据和宫颈前庭诱发肌源性电位(cVEMP)阈值,这些患者报告术后症状完全缓解和一种或多种症状持续存在.上管裂开(SCD)缺损大小的放射学计算机断层扫描(CT)测量,location,并比较了这两组之间的侧向性。
■在我们研究的126名患者(132耳)中,119例患者(90.2%)报告术后缓解(n=82,62.1%)或改善(n=37,28.0%)的主要(最麻烦的)症状,而13例患者(9.8%)报告原发性症状持续存在.手术和问卷完成之间的中位数(四分位数范围)和范围为9(4-28),1-124个月,分别。分析所有症状(原发性和非原发性)69例(52.3%)和68例(51.1%)患者报告术后听觉和前庭症状完全消退,分别。最可能的持续性症状包括失衡(33/65/67,50.8%),位置性头晕(7/20,35.0%)和示波(44/15,26.7%)。与持续性听觉症状相关的因素包括癫痫发作史(0%vs.7.6%,p=0.023),听觉主诉(50.0%vs.70.5%),较高的PTA(平均19.6vs.25.1dB,p=0.043)和1000Hz时宫颈前庭诱发肌源性电位(cVEMP)阈值较高(平均66.5vs.71.4,p=0.033)。偏头痛诊断(14.0%vs.41.9%p<0.010),双侧放射学SCD(17.5%vs.38.1%,p=0.034)和修订病例(0.0%与14.0%,p=0.002)与持续性前庭症状有关。SCD缺损大小和位置与症状持续性均无显著相关性(P>0.05)。
■SCDS的手术修复可显著减轻大多数听觉和前庭症状。然而,某些人的坚持,主要是非小学的,症状和识别潜在的相关因素,包括偏头痛,PTA阈值,cVEMP阈值,双侧SCD,和修订案例强调了个性化患者咨询和管理策略的重要性。
UNASSIGNED: Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair.
UNASSIGNED: Retrospective chart review.
UNASSIGNED: Tertiary neurotology single-institution care center.
UNASSIGNED: The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (
cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups.
UNASSIGNED: Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (
cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05).
UNASSIGNED: Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds,
cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.