Surgery

Surgical Repair

The bone surrounding the superior canal is one of the few bones in the body that does not repair itself. As such, the dehiscence will never heal by itself.

As mentioned, some SCDS patients are able to adjust to their symptoms over time. In those cases, it is recommended to keep with symptom management, and have follow-up appointments with an ENT specialist.

For those that have symptoms that severely impact their quality-of-life, surgery is an option to consider. 

Finding a Surgeon

When considering surgery, it is important to remember:

• Surgery to repair SCDS is an invasive, extremely delicate operation.
• Recovery typically takes several weeks or months.

As such, it is critical to find a specialist surgeon that is very knowledgeable of SCDS, and has a proven record of successful surgeries.

Types of Surgery

The superior canal is located behind the skull near your ear, and resides underneath the brain's dura (the protective membrane that surrounds the brain). Because of this location, an opening in the skull must be created by the surgeon in order to access the inner ear and repair the dehiscence.

There are two different types of surgeries used in SCDS operations:

• Transmastoid (referred to online as TM)
• Middle Fossa Craniotomy (referred to online as MFC)

TM and MFC have the same types of risks (such as hearing loss), and total recovery time is approximately the same on average.

Your surgeon will recommend which approach to use based on several factors, including the location of the dehiscence.

Transmastoid (TM) Approach

TM surgery is performed behind the ear, and is the least-invasive of the two types of surgeries. It can be performed by an ENT surgeon alone, and is typically considered an out-patient day surgery. The downside to the TM approach is that the surgeon has no direct visualization of the dehiscence.

Middle Fossa Craniotomy (MFC) Approach

MFC surgery is performed by making an opening in the skull above the ear. MFC is a more invasive surgery that requires both an ENT and a neurosurgeon, as the brain dura must be lifted slightly to access the inner ear. However, the MFC approach allows the surgeon to have a complete visualization of the dehiscence. 

Types of Repairs

During the surgery -- whether TM or MFC -- the surgeon will repair the dehiscence using one of several methods:

• Plugging - this is where the surgeon plugs the canal completely, closing the canal. This method helps prevent SCDS symptoms from reoccurring long-term.
  • The downside is that this reduces or disables the functionality of that canal, which can cause dizziness and balance issues after surgery. However, the brain typically re-adjusts within several weeks or months, and vestibular rehabilitation therapy can assist with the recovery.
    
    
• Resurfacing (sometimes called Sealing or Capping) - this type of repair attempts to cover the hole caused by the dehiscence without plugging the canal.
  • The advantage to this type of repair is that it can help preserve the function of the superior canal by not disabling it, which can reduce post-operative dizziness. However, resurfacing alone has the risk of the repair material being reabsorbed by the body overtime, which could allow the dehiscence to reappear.

In many cases, surgeons will use both methods to ensure the best long-term results.

Repair Images

Plugging of the superior canal:

Resurfacing plus plugging of the superior canal:

Surgery Recovery

Based on anecdotal observations, the average recovery time from SCDS surgery is around 6 weeks.

It is normal for patients to experience severe dizziness and vertigo in the early days of the recovery process. These post-operative symptoms will gradually improve over the initial weeks as your brain retrains its balance system. You may not be able to hear out of the operated ear either for the initial first few weeks, as the canal will be initially clogged with dried blood from the surgery.

My SCDS Surgery Experience

I had successful MFC surgery in 2022. Surgery wasn’t as scary as I thought it would be, and while full recovery was frustrating and slow, it wasn’t painful.

Everyone's recovery is different, but I feel like my experience was pretty close to the average recovery:

• I spent 2 nights in the hospital recovering.
• I was able to leave the hospital unassisted on Day 3 (though I was told patients typically need assistance with mobility still at this point).
• Pain was minimal, and managed mostly with Tylenol, which I stopped needing around Day 4.
• Severe vertigo kicked in on Day 5, which I was warned would happen as inflammation began. I vomited several times on Day 5, but luckily partying in my 20s prepared me for that experience. Lesson: have a bucket nearby the first few days! 😅
• What did vertigo feel like? It felt like being on a rocking boat, where the floor would wobble unevenly, and having a lot of nausea.
• For the nausea, over-the-counter Dramamine/Gravol was enough to eventually handle it (stock up on it beforehand).
• Walking is the best way to help retrain your balance after surgery. I tried to go for a 30 minute walk every day. Some days this was easy to do, some days it was challenging.
• While walking around the first few weeks, I looked and felt extremely drunk, and started measuring recovery in terms of drinks:

• • Weeks 1-2 felt like I had just drank a bottle of whiskey every day.
  • Week 3 felt like I had drunk 6 beers.
  • Week 4 felt like I was down to 2 beers.
  • Week 6: balance fully restored.
• In terms of hearing, you probably won't be able to hear out of the operated ear initially. This is normal. Progress for myself went like this:
  
  
  • Weeks 1-2: no hearing (due to fluid blocking the entire canal).
  • Weeks 3-4: partial hearing, with all kinds of weird internal sounds (clicks, different frequencies, etc).
  • Weeks 5-6: hearing at 50% restored.
  • Week 8: hearing fully restored.

Honestly, the hardest part about the surgical recovery is patience. The mind recovers faster than the body does from the surgery, and often I felt frustrated and bored with slow, incremental improvements over the weeks. Having some kind of engaging personal project to work on during the first month will definitely help.


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