Superior Canal Dehiscence Syndrome

Superior canal dehiscence syndrome is a rare condition where there’s a hole in the bone that covers a key inner ear structure. This structure — the superior semicircular canal — is one of three coiled tubes inside your inner ear. An important part of your vestibular system, this canal is filled with fluid that shifts when you move. Your brain uses this information to regulate your balance.

But with SCDS, an opening (dehiscence) or thinning bone interferes with balance signals. It can allow sounds to travel to your brain. This can change your hearing.

The good news is that SCDS is treatable. If you’re having symptoms, a healthcare provider can likely help.

Symptoms of superior canal dehiscence syndrome

SCDS symptoms can impact both your hearing and balance. They include:

• Hearing loss (especially at low frequencies)
• Heightened sensitivity to sound (hyperacusis)
• Hearing your voice or internal sounds, like breathing or blinking, as unusually loud
• Hearing noises in your head that happen in time with your pulse or heartbeat (pulsatile tinnitus)
• The feeling that objects are moving when they shouldn’t be (oscillopsia)
• Feeling like you’re spinning when you’re not (vertigo)

Activities that change the pressure in your brain or ear can trigger vertigo and oscillopsia. Examples include coughing, exercising, heavy lifting, hearing loud noises and sneezing.

SCDS causes

Superior canal dehiscence syndrome happens when there’s a hole in the bone covering your superior semicircular canal. The opening causes a communication breakdown between your brain and your inner ear.

Doctors don’t know for sure what causes problems with the bone. But it’s likely that many factors play a role. It may be that the bone near your superior canal doesn’t thicken enough during fetal development. Infections or head trauma (injury) may also cause SCDS. Or a bone that’s already thin may get even thinner with age.

Complications of this condition

With severe SCDS, you may develop brain-related symptoms, like brain fog and headaches. You may also have mental health issues. Isolating to avoid exposing yourself to unpleasant sounds can lead to anxiety and depression.

This is why it’s so important to see a healthcare provider if you’re experiencing issues. You don’t have to accept a reduced quality of life just because you have SCDS.

How doctors diagnose this condition

You’ll likely see a neurotologist to diagnose and treat your condition. A neurotologist is a doctor who specializes in brain- and nerve-related concerns that also involve your ears. They may order several tests, including:

• Computed tomography (CT scan): This imaging procedure can show the opening in your bone covering the superior semicircular canal.
• Hearing test: An audiologist will test your hearing.
• VEMP test: This test provides information about how the parts of your inner ear are working to control your balance. You’ll move your head to the left or right, or look up, while staring at a target and listening to a series of tones.

How is SCDS treated?

Treatment for mild symptoms usually involves management techniques. Options include lifestyle changes or vestibular therapy to help with balance issues. If your symptoms are severe, you may need surgery to repair the bone.

Management techniques

You can manage symptoms by avoiding activities that trigger balance issues. You can also protect your ears from excess noise. Things you can do include:

• Wearing earplugs
• Avoiding loud environments when possible
• Whispering (if your voice sounds too loud)
• Avoiding activities that trigger balance problems, like heavy lifting
• Avoiding activities that can cause pressure changes in your ear, like flying

Seeking treatment from a certified vestibular physical therapist can help manage symptoms. They can teach you exercises to help improve your balance and reduce your risk of falls.

Surgery

You may need surgery if management isn’t helping enough. The most common surgical repairs for SCDS include:

• Plugging the opening: This technique closes the opening using bone or connective tissue. This procedure involves accessing your inner ear through an opening in your skull or behind your ear.
• Resurfacing: This repair technique covers the opening without closing it completely. It’s less common than plugging.

Your healthcare provider may use both plugging and resurfacing techniques during surgery.

What can I expect if I have superior canal dehiscence syndrome?

Most people are able to manage symptoms once they learn techniques to manage them. But the actual opening won’t go away on its own. Unlike other bones in your body, the bone that surrounds your superior semicircular canal doesn’t repair itself.

SCDS surgery decreases or relieves symptoms for most people. Some studies show that certain symptoms resolve more quickly following surgery than others. For example, hearing loss and vertigo may improve faster than headaches and brain fog.

Talk to your healthcare provider about what you should expect from surgery.

Is superior canal dehiscence syndrome a disability?

It may be, depending on your symptoms and the type of work you do. If you have a hearing issue, you can request reasonable accommodations to do your job, according to the Americans with Disabilities Act. Ask your healthcare provider for guidance on how to apply for accommodations for work.