The other day I had a follow up appointment with the ENT, following my VEMP testt last month. It would seem that the VEMP test backs up the findings of the CT scan, and confirms the diagnosis of Superior Semi circular canal dehiscence. It also suggests that I am bilateral, ie have a hole in the canal in both ears.
This all means that they consider me a candidate for surgery. In the UK that pretty much exclusively means that surgery will be done by the Trans-Mastoid approach, and the hole itself will either be patched or plugged. Let me explain this a little further.
There are two surgical techniques that are used to fix SCDS. One approach is Mid-fossa Craniotomy, which is a very invasive procedure, which involves making an incision through the skull and coming at the hole from the top down. The plus side of this is that they can see the hole, the downside is that due to the invasive nature there are extra risks involved.
The second approach is the Trans Mastoid approach, where they come into the inner ear through the mastoid bone behind your ear. This is less invasive, it does not require having to lift the brain, and therefore carries less risk. But the downside is that they cannot visualise the dehiscence. The Transmastoid approach is the technique that is used in the UK. The US uses both techniques.
Once they have gained access to the inner ear, there are two ways of fixing it. They can either put a patch over the hole, or plug the entire canal. Putting a patch over the hole would maintain the function of the canal, but it is not as durable as plugging, and if it is not in the right place, then the surgery will fail. Plugging the canal, is where they fill the canal with a sealing substance, and therefore seals the hole. But by plugging the canal you lose the function of the canal, which could affect balance. However, with Vestibular therapy, it is hoped that they brain learns to compensate for that loss.
As you can see, it is not straightforward, and there will be various decisions to be made. The first decision for me, was getting a surgeon who had done this procedure before. As nice my ENT consultant was, he admitted he hadn't done this surgery as a consultant before, and I really didn't fancy being the first. So I am being referred to a consultant who has a few of these surgeries under his belt. The problem with having a rare condition that has only been known about for the last 20 years, is that even the experts are still learning about the condition, and not that many surgeries (in the scale of things) have been undertaken. Techniques are being improved upon all the time, and the longevity of the surgeries is still being discovered.
That being said, I have a condition that has a chance of being fixed. I have a chance of getting my pre-SCDS life back. So I await surgery.
