ANS033 - NICHOLAS TOROK VESTIBULAR AWARDVestibular Migraine Confounds Management of Superior Canal Dehiscence Syndrome
Sunday, May 1, 2022
10:27 AM – 10:34 AM CT
Location: Landmark A
Miriam R. Smetak, MD, MS
Nathan D. Cass, MD
Nauman F. Manzoor, MD
Kelsey Hatton, AuD, CCC-A
Matthew R. O'Malley, MD
Marc L. Bennett, MD, MMHC
David S. Haynes, MD, MMHC
Resident Physician Vanderbilt University Medical Center Nashville, Tennessee
Objective: To investigate the prevalence of vestibular migraine (VM) in a cohort of patients with radiologic confirmation of superior canal dehiscence (SCD) and to compare management of superior canal dehiscence syndrome (SCDS) in patients with and without comorbid VM.
Study Design: Retrospective review of a SCD database
Setting: University-based tertiary medical center
Patients: 91 patients identified with SCDS from 2008 to 2017
Interventions: None
Main Outcome Measures: Coincidence of VM and SCD, resolution of symptoms
Results: Ninety-one patients with SCD met inclusion and exclusion criteria. VM was diagnosed in 36 (39.6%) patients. Of those receiving medical therapy for VM alone, 5 (45.5%) reported symptom resolution, 5 (45.5%) reported partial improvement, 1 (9.1%) had no change, and none worsened. Fifteen patients (41.7%) were treated with both surgery (for SCD) and medical therapy (for VM). Seven (46.7%) reported symptom resolution, 7 (46.7%) reported partial improvement, and 1 (6.7%) worsened. There was no statistically significant difference in symptom resolution between SCD+VM patients who were treated medically compared with those treated with medical therapy and surgery (p =0.95). There was no significant difference in symptom resolution after surgery between SCD+VM and SCD-only cohorts (p = 0.29).
Conclusions: This is the first study describing the incidence of VM in a cohort of patients with SCDS. The symptoms of VM confound those of SCDS and unrecognized or undertreated VM may contribute to surgical failure in SCDS. Therefore, we recommend a high index of suspicion for VM in patients with SCDS and a trial of medical therapy in the setting of suspected VM.
*Professional Practice Gap & Educational Need: A significant number of patients with SCDS in this cohort have a comorbid diagnosis of VM. Many have persistence of symptoms after surgical correction of SCD. Part of this treatment failure may be related to co-existence of VM in this patient population.
*Learning Objective: To better understand the patient-specific factors that may lead to failure of surgical treatment forSCD, specifically the high prevalence of comorbid VM.
*Desired Result: A high level of suspicion should be maintained for the coexistence of VM in patients with radiographic finding of SCD.
*Level of Evidence - LEVEL V – Case series, studies with no controls
*Indicate IRB or IACUC: Vanderbilt University Medical Center, IRB #201632 (approved 08/15/2020).