For people who have severe symptoms of superior canal dehiscence syndrome (SCDS) , surgery to fix the hole in the superior semicircular canal may be an option. 

Who may need surgery for superior canal dehiscence syndrome?

People diagnosed with SCDS who have severe hearing or balance problems may consider surgery. On the other hand, people who have a gap in the bone of the superior semicircular canal but do not have symptoms usually do not need surgery. An ear specialist, also known as an otologist or neurotologist, can help people who have superior canal dehiscence determine the cause of their symptoms and if surgery is likely to help. 

In some cases, SCDS can raise the risk of falling and hearing loss, affecting the person’s safety and well-being. When nonsurgical approaches such as avoiding triggers or vestibular therapy do not provide the desired relief, surgery may help. However, people should not have surgery based on the fear of worsening symptoms, because SCDS symptoms usually do not become worse over time, although they may become less tolerable.

Outcomes After SCDS Surgery

Research shows that 70% to 90% of people who have surgery for SCDS say their symptoms improve. However, shortly after the surgery, balance may worsen for a while, which can be addressed with vestibular physical therapy. 

A surgeon experienced in SCDS surgery can help you decide if the procedure is a good option for you and can explain what results to expect. 

Preparing for SCDS Surgery

Your doctor will give you clear instructions on how to prepare for SCDS surgery, which may include:

• Visiting your regular doctor before the surgery
• Planning to stay in the hospital for one to three nights and to take several weeks off from work
• Make sure someone can take you to and from the hospital
• Arrange for someone to help you at home during the first few weeks of recovery

What Happens During SCDS Surgery

• During SCDS surgery, the patient is under general anesthesia (asleep).
• The surgeon makes an opening in the skull above the ear to reach the inner ear and the base of the skull.
• The surgeon finds the hole in the superior semicircular canal and repairs it by plugging it or covering it up. Fascia, bone dust and bone chips can be used to plug the hole, which is then covered with bone cement for added security. The goal is to make sure the walls inside the ear are strong again.
• After the repair is complete, the surgeon returns the bone removed when opening the skull, and the skin is closed over it. 

Sometimes, the surgeon may choose to make the skull opening behind the ear rather than above. Called a transmastoid approach, this offers access to the inner ear through the mastoid part of the ear bone. Deciding on which surgical approach is used depends on where the superior semicircular canal opening is located and other health issues.

Superior Canal Dehiscence Syndrome Surgery – Patient and Physician Discuss Post-Surgery Experience

Risks of SCDS surgery

Your doctor will explain the risks and benefits of each surgical approach. Common risks include the possibility of hearing loss and worsening of dizziness (vertigo and imbalance). Some people still hear sounds differently (such as their voice or heartbeat) after the surgery because there is a temporary collection of fluid behind the eardrum. But over time, the body will get rid of the extra fluid and these symptoms typically will go away. 

Recovering from SCDS Surgery

Hospital Stay 

After surgery, you will be transported to a recovery room. The hospital stay after SCDS surgery is typically one to three days, which allows the medical team to monitor healing and recovery. While at the hospital:

• You will be given medicine, such as steroids, to control pain and to reduce swelling and inflammation at the surgical site. Some patients may need additional medicine to help control blood sugar when taking steroids.
• You may also be given medicines such as stool softeners to avoid constipation and blood thinners to prevent blood clots.
• You may have a tube in your bladder to drain urine and a tube in your arm for medicines. These will be removed before you leave the hospital.
• A vestibular therapist (a type of physical therapist) may teach you exercises to help with balance issues after surgery.

Recovery at Home

Recovery from superior canal dehiscence surgery can take a while. For six weeks, it is important to take it easy and avoid doing anything that builds up pressure inside the head, such as lifting heavy objects or straining. Your doctor will want to check on your recovery and your hearing, so you might be asked to see the doctor for follow-up visits and tests. 

Vestibular Physical Therapy After SCDS Surgery

Vestibular physical therapy is an important part of recovery after SCDS surgery. The surgery can change the balance function in the semicircular canals, and therapy can help people return to normal by retraining the brain to register balance properly.

Vestibular physical therapy can be challenging because some of the exercises may cause symptoms like dizziness and unsteadiness, which can make you feel sick at first. However, working with an experienced vestibular therapist can make you feel confident in the process and help you stick with it. 

Superior Canal Dehiscence Syndrome Surgery – Patient and Physician Discuss One-Sided SCDS Repair