Conservative Treatment of Superior Canal Dehiscence (SCD)

Timothy C. Hain, MD   • Page last modified: July 24, 2021

See also: SCD (overview) SCD bedside diagnosisSCD lab diagnosisSCD radiology diagnosisSCD conservative treatmentsSCD surgical treatmentSCD references

Basically, one can either avoid things that make you dizzy or cause hearing related symptoms, or you can have surgery.

In our own practice, Chicago Dizziness and Hearing in Chicago Illinois, we have accumulated 100 SCD patients in our database over the last few years. However, only about 1/5 patients are operated. Patients have simply generally not opted for surgery because of the risk of hearing loss, and also reasonable concern about the craniotomy (i.e. drilling of the skull) often recommended for the "roofing" or "capping" procedures. Patients more likely to opt for surgery are those with prominent auditory symptoms, for example hearing their voice in their head, or pulse in the head (pulsatile tinnitus), or prominent dizziness (e.g. dizziness when doing something as simple as burping).

Watch/wait treatment of SCD (Conservative)

SCD does not change very rapidly -- people often wait many years, or forever, before having surgery.

Patients with dehiscence may wish to avoid:

These are the things you might wish to do to mitigate symptoms:

1. Avoid loud nose -- for example, if you play a musical instrument, better find another hobby.

2. Avoid pressure fluctuations between your ear and the rest of your body -- this isn't easy, as nearly any type of exertion has the potential for producing pressure fluctuation. It is not that there is a danger from this activity -- it just may give make you dizzy. Weight lifting, straining to do things, strenuous sexual activity - -these are all things that might cause trouble. Some musical instruments, involve a lot of lung pressure (such as the French Horn) and thus have another reason to trigger SCD symptoms. .

3. Avoid pressure fluctuations between your middle ear and external ear -- in other words, avoid situations where your ear might pop. Again, there is no real danger (other than that of falling or driving off the road), but you might get pretty dizzy.

On airplanes, our patients have indicated that ear plugs are often helpful in this situation also. The "ear plane" ear plugs are designed to reduce pressure fluctuation, and may be useful. If these are not possible or available, we suggest using a nasal decongestant at least one half hour prior to landing.

4. A ventilation tube may help. This positive effect is due to reduced movement of the tympanic membrane, ossicular chain, and stapes footplate, and therebye reduction of pressure on the middle ear. This is only useful for vertigo. It does not help hyperacusis or tinnitus. OK, this is minor surgery.

5. Medications are not terribly useful.

Case example: An otherwise healthy man developed positional vertigo. On examination he was noted to have both a positional nystagmus (downbeating) as well as pulse-synchronous nystagmus (see video above). A VEMP was abnormal and this was followed by a temporal-bone CT scan which documented clear superior canal dehiscence. As his symptoms were minor, he opted to do nothing.

Research:

While the diagnosis of SCD has become much easier in recent years, treatment has lagged behind. More work is needed to work out the best approach for treatment.

Summary of conservative treatment of SCD:

Conservative treatment is usually the first step after SCD is diagnosed. If conservative treatment fails, then surgical treatment is consdered. This page discusses surgery. SCD surgical treatment

See also: SCD (overview) SCD bedside diagnosisSCD lab diagnosisSCD radiology diagnosisSCD conservative treatmentsSCD surgical treatmentSCD references