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Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?

Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test...

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Autores principales: Castellucci, Andrea, Malara, Pasquale, Martellucci, Salvatore, Alfarghal, Mohamad, Brandolini, Cristina, Piras, Gianluca, Armato, Enrico, Ruberto, Rosanna Rita, Brizzi, Pasquale, Presutti, Livio, Ghidini, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604197/
https://www.ncbi.nlm.nih.gov/pubmed/37887852
http://dx.doi.org/10.3390/audiolres13050071
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author Castellucci, Andrea
Malara, Pasquale
Martellucci, Salvatore
Alfarghal, Mohamad
Brandolini, Cristina
Piras, Gianluca
Armato, Enrico
Ruberto, Rosanna Rita
Brizzi, Pasquale
Presutti, Livio
Ghidini, Angelo
author_facet Castellucci, Andrea
Malara, Pasquale
Martellucci, Salvatore
Alfarghal, Mohamad
Brandolini, Cristina
Piras, Gianluca
Armato, Enrico
Ruberto, Rosanna Rita
Brizzi, Pasquale
Presutti, Livio
Ghidini, Angelo
author_sort Castellucci, Andrea
collection PubMed
description Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test (vHIT) represents a common finding in patients with SCD exhibiting sound/pressure-induced vertigo, a low-frequency air–bone gap (ABG), and enhanced vestibular-evoked myogenic potentials (VEMPs). “Spontaneous canal plugging” has been assumed as the underlying process. Nevertheless, missing/mitigated symptoms and/or near-normal instrumental findings would be expected. An endolymphatic flow dissipation has been recently proposed as an alternative pathomechanism for SSC VOR gain reduction in SCD. We aimed to shed light on this debate by comparing instrumental findings from 46 ears of 44 patients with SCD exhibiting SSC hypofunction with post-operative data from 10 ears of 10 patients with SCD who underwent surgical plugging. While no difference in SSC VOR gain values was found between the two groups (p = 0.199), operated ears developed a posterior canal hypofunction (p = 0.002). Moreover, both ABG values (p = 0.012) and cervical/ocular VEMP amplitudes (p < 0.001) were significantly higher and VEMP thresholds were significantly lower (p < 0.001) in ears with SCD compared to operated ears. According to our data, canal VOR gain reduction in SCD should be considered as an additional sign of a third window mechanism, likely due to an endolymphatic flow dissipation.
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spelling pubmed-106041972023-10-28 Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation? Castellucci, Andrea Malara, Pasquale Martellucci, Salvatore Alfarghal, Mohamad Brandolini, Cristina Piras, Gianluca Armato, Enrico Ruberto, Rosanna Rita Brizzi, Pasquale Presutti, Livio Ghidini, Angelo Audiol Res Article Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test (vHIT) represents a common finding in patients with SCD exhibiting sound/pressure-induced vertigo, a low-frequency air–bone gap (ABG), and enhanced vestibular-evoked myogenic potentials (VEMPs). “Spontaneous canal plugging” has been assumed as the underlying process. Nevertheless, missing/mitigated symptoms and/or near-normal instrumental findings would be expected. An endolymphatic flow dissipation has been recently proposed as an alternative pathomechanism for SSC VOR gain reduction in SCD. We aimed to shed light on this debate by comparing instrumental findings from 46 ears of 44 patients with SCD exhibiting SSC hypofunction with post-operative data from 10 ears of 10 patients with SCD who underwent surgical plugging. While no difference in SSC VOR gain values was found between the two groups (p = 0.199), operated ears developed a posterior canal hypofunction (p = 0.002). Moreover, both ABG values (p = 0.012) and cervical/ocular VEMP amplitudes (p < 0.001) were significantly higher and VEMP thresholds were significantly lower (p < 0.001) in ears with SCD compared to operated ears. According to our data, canal VOR gain reduction in SCD should be considered as an additional sign of a third window mechanism, likely due to an endolymphatic flow dissipation. MDPI 2023-10-20 /pmc/articles/PMC10604197/ /pubmed/37887852 http://dx.doi.org/10.3390/audiolres13050071 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Castellucci, Andrea
Malara, Pasquale
Martellucci, Salvatore
Alfarghal, Mohamad
Brandolini, Cristina
Piras, Gianluca
Armato, Enrico
Ruberto, Rosanna Rita
Brizzi, Pasquale
Presutti, Livio
Ghidini, Angelo
Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title_full Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title_fullStr Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title_full_unstemmed Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title_short Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: “Spontaneous Plugging” or Endolymphatic Flow Dissipation?
title_sort impaired vestibulo-ocular reflex on video head impulse test in superior canal dehiscence: “spontaneous plugging” or endolymphatic flow dissipation?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604197/
https://www.ncbi.nlm.nih.gov/pubmed/37887852
http://dx.doi.org/10.3390/audiolres13050071
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