Download PDF
J Am Acad Audiol 2020; 31(01): 076-082
DOI: 10.3766/jaaa.18076
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Symptoms, Audiometric and Vestibular Laboratory Findings, and Imaging in a Concurrent Superior Canal Dehiscence Syndrome and Vestibular Schwannoma: A Case Report

Doug Garrison
*   Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Hospital, Durham, NC
,
Laura Barth
*   Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Hospital, Durham, NC
,
David Kaylie
†   Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
,
Kristal Riska
†   Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
› Author Affiliations
Further Information

Publication History

12 October 2018

Publication Date:
25 May 2020 (online)

   Permissions and Reprints

Abstract

Background:

Dizziness is a common complaint that can arise from multiple systems in the body. Objective vestibular tests are used to understand the underlying function of the vestibular system and whether or not it may be contributing to the dizziness symptoms experienced by the patient. Even when comprehensive case history is consistent with an otologic etiology, audiometric and vestibular tests are ordered to objectively characterize inner ear function to help further refine the differential diagnoses and aid in guiding treatment options. Few reports in the literature describe audiometric and vestibular results in patients with multiple concurrent otologic etiologies.

Purpose:

This case provides a description of audiometric, vestibular, and imaging results in a case of concurrent bilateral superior canal dehiscence, right-sided vestibular schwannoma, and right-sided posterior canal benign paroxysmal positional vertigo. The patient’s symptoms and laboratory findings are described in detail and, where appropriate, highlight challenges that may arise in interpretation.

Research Design:

A case report.

Results:

The patient presented for evaluation of dizziness, asymmetric hearing loss, and autophony. Comprehensive audiometric evaluation shows asymmetric sensorineural hearing loss and an air-bone gap at 250 Hz in the right ear. Vestibular evaluation shows right caloric asymmetry along with abnormal cervical vestibular– and ocular vestibular–evoked myogenic potentials, with the left ear showing results consistent with the third-window pathology.

Conclusions:

Comprehensive assessment of symptoms and critical thinking while performing testing are necessary when examining multiple concurrent otologic etiologies in a patient. Knowledge of anticipated test results and physiology may help the audiologist to synthesize results and make appropriate clinical recommendations as part of the multidisciplinary team.

Key Words

acoustic neuroma - audiometry - benign paroxysmal positional vertigo - superior semicircular canal dehiscence - vestibular function tests - vestibular schwannoma
 

  • REFERENCES

  • Aaron KA, Lavinsky J, Tuchman A, Go JL, Giannotta SL, Friedman RA. 2015; A case report of two different skull base pathologies causing hearing loss in the same ear: vestibular schwannoma and superior semicircular canal dehiscence. Am J Otolaryngol 36 (03) 488-491
    CrossrefPubMedGoogle Scholar
  • Agrawal Y, Minor L, Schubert M, Janky K, Davalos-Bichara M, Carey J. 2012; Second-side surgery in superior canal dehiscence syndrome. Otol Neurotol 33 (01) 72-77
    CrossrefPubMedGoogle Scholar
  • Carey J, Minor L, Nager G. 2000; Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg 126: 137-147
    CrossrefPubMedGoogle Scholar
  • Fife TD. 2017; Dizziness in the outpatient care setting. Continuum (Minneap Minn) 23 (02) 359-395
    Google Scholar
  • Goebel JA. 2001; The ten-minute examination of the dizzy patient. Semin Neurol 21 (04) 391-398
    Article in Thieme ConnectPubMedGoogle Scholar
  • Jongkees LBW, Philipszoon AJ. 1964; Electronystagmography. Acta Otolaryngol Suppl 189: 1-111
    Google Scholar
  • Lin D, Hegarty JL, Fischbein NJ, Jackler RK. 2005; The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg 131 (03) 241-244
    CrossrefPubMedGoogle Scholar
  • Manzari L, Burgess AM, McGarvie LA, Curthoys IS. 2013; An indicator of probable semicircular canal dehiscence: ocular vestibular evoked myogenic potentials to high frequencies. Otolaryngol Head Neck Surg 149: 142-145
    CrossrefPubMedGoogle Scholar
  • Merchant S, Rosowski J. 2008; Conductive hearing loss caused by third-window lesions of the inner ear. Otol Neurotol 29: 282-289
    CrossrefPubMedGoogle Scholar
  • Minor L, Solomon D, Zinreich J, Zee D. 1998; Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 124: 249-258
    CrossrefPubMedGoogle Scholar
  • Minor L. 2005; Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 115: 1717-1727
    CrossrefPubMedGoogle Scholar
  • Post RE, Dickerson LM. 2010; Dizziness: a diagnostic approach. Am Fam Physician 82 (04) 361-368
    PubMedGoogle Scholar
  • Selesnick S, Jackler R, Pitts L. 1993; The changing clinical presentation of acoustic tumors in the MRI era. Laryngoscope 103: 431-436
    CrossrefPubMedGoogle Scholar
  • Yuen H, Boeddinghaus R, Eikelboom R, Atlas M. 2009; The relationship between the air-bone gap and the size of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 141: 689-694
    CrossrefPubMedGoogle Scholar
  • Zuniga G, Janky K, Nguyen K, Welgampola M, Carey J. 2013; Ocular versus cervical VEMPs in the diagnosis of superior semicircular canal dehiscence syndrome. Otol Neurotol 34 (01) 121-126
    CrossrefPubMedGoogle Scholar