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CT Evaluation of Bone Dehiscence of the Superior Semicircular Canal as a Cause of Sound- and/or Pressure-induced Vertigo¹

¹ From the Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (C.J.B.); Dr Noah Weg & Associates, Suffern, NY (N.W.); and Departments of Otolaryngology-Head and Neck Surgery (L.B.M., S.J.Z.) and Radiology (S.J.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, Rm 6253, Baltimore, MD 21287-0910. From the 1998 RSNA scientific assembly. Received May 4, 2001; revision requested July 9; final revision received July 16, 2002; accepted August 9. Address correspondence to L.B.M. (e-mail: lminor@jhmi.edu).

View larger version (193K): [in a new window]   Figure 1a. Rating of the bone covering the SSC used for the 1-mm-collimated CT scans in the control subjects with normal temporal bones. (a) Coronal 1-mm-collimated CT scan through the left temporal bone shows clearly intact bone (arrow) over the left SSC. (b) Coronal 1-mm-collimated CT scan through the left temporal bone demonstrates an area of possible bone dehiscence (arrow) over the SSC. (c) Coronal 1-mm-collimated CT scan through the right temporal bone demonstrates a region of bone dehiscence (arrow) over the SSC.

View larger version (150K): [in a new window]   Figure 1b. Rating of the bone covering the SSC used for the 1-mm-collimated CT scans in the control subjects with normal temporal bones. (a) Coronal 1-mm-collimated CT scan through the left temporal bone shows clearly intact bone (arrow) over the left SSC. (b) Coronal 1-mm-collimated CT scan through the left temporal bone demonstrates an area of possible bone dehiscence (arrow) over the SSC. (c) Coronal 1-mm-collimated CT scan through the right temporal bone demonstrates a region of bone dehiscence (arrow) over the SSC.

View larger version (184K): [in a new window]   Figure 1c. Rating of the bone covering the SSC used for the 1-mm-collimated CT scans in the control subjects with normal temporal bones. (a) Coronal 1-mm-collimated CT scan through the left temporal bone shows clearly intact bone (arrow) over the left SSC. (b) Coronal 1-mm-collimated CT scan through the left temporal bone demonstrates an area of possible bone dehiscence (arrow) over the SSC. (c) Coronal 1-mm-collimated CT scan through the right temporal bone demonstrates a region of bone dehiscence (arrow) over the SSC.

View larger version (119K): [in a new window]   Figure 2a. Normal appearance of the roof of the SSC. (a) Oblique coronal reformation through the temporal bone demonstrates three distinct layers: cortical bone of the petrous pyramid (solid arrow), bone of the otic capsule (arrowhead), and the interposed mastoid air cells. The superior petrosal sinus (open arrow) is also seen. (b) Oblique coronal reformation through the temporal bone demonstrates a two-layer covering (arrow) of the SSC that consists of otic capsule and cortical bone of the petrous pyramid together. (c) Oblique coronal reformation through the temporal bone demonstrates a one-layer bone covering (arrow) over the SCC.

View larger version (127K): [in a new window]   Figure 2b. Normal appearance of the roof of the SSC. (a) Oblique coronal reformation through the temporal bone demonstrates three distinct layers: cortical bone of the petrous pyramid (solid arrow), bone of the otic capsule (arrowhead), and the interposed mastoid air cells. The superior petrosal sinus (open arrow) is also seen. (b) Oblique coronal reformation through the temporal bone demonstrates a two-layer covering (arrow) of the SSC that consists of otic capsule and cortical bone of the petrous pyramid together. (c) Oblique coronal reformation through the temporal bone demonstrates a one-layer bone covering (arrow) over the SCC.

View larger version (123K): [in a new window]   Figure 2c. Normal appearance of the roof of the SSC. (a) Oblique coronal reformation through the temporal bone demonstrates three distinct layers: cortical bone of the petrous pyramid (solid arrow), bone of the otic capsule (arrowhead), and the interposed mastoid air cells. The superior petrosal sinus (open arrow) is also seen. (b) Oblique coronal reformation through the temporal bone demonstrates a two-layer covering (arrow) of the SSC that consists of otic capsule and cortical bone of the petrous pyramid together. (c) Oblique coronal reformation through the temporal bone demonstrates a one-layer bone covering (arrow) over the SCC.

View larger version (114K): [in a new window]   Figure 3a. Vertigo induced by loud noises in the left ear of a 37-year-old man. Clinical examination findings indicated vertical-torsional eye movements in the plane of the left SSC induced by tones of 500-1,000 Hz at the 110-dB hearing level in the left ear. Dehiscence of bone overlaying the left SSC was confirmed at surgery. (a) Coronal 0.5-mm-collimated CT scan through the right temporal bone demonstrates an intact layer of bone (arrow) over the SSC. (b) Multiplanar reformation in an oblique sagittal orientation confirms the presence of an intact layer of bone (arrows) overlaying the right SSC. (c) Coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates dehiscence of bone (arrow) overlaying the left SSC. (d) Multiplanar reformation in an oblique sagittal orientation through the left temporal bone demonstrates an area of dehiscence (arrows) overlaying the left SSC.

View larger version (132K): [in a new window]   Figure 3b. Vertigo induced by loud noises in the left ear of a 37-year-old man. Clinical examination findings indicated vertical-torsional eye movements in the plane of the left SSC induced by tones of 500-1,000 Hz at the 110-dB hearing level in the left ear. Dehiscence of bone overlaying the left SSC was confirmed at surgery. (a) Coronal 0.5-mm-collimated CT scan through the right temporal bone demonstrates an intact layer of bone (arrow) over the SSC. (b) Multiplanar reformation in an oblique sagittal orientation confirms the presence of an intact layer of bone (arrows) overlaying the right SSC. (c) Coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates dehiscence of bone (arrow) overlaying the left SSC. (d) Multiplanar reformation in an oblique sagittal orientation through the left temporal bone demonstrates an area of dehiscence (arrows) overlaying the left SSC.

View larger version (125K): [in a new window]   Figure 3c. Vertigo induced by loud noises in the left ear of a 37-year-old man. Clinical examination findings indicated vertical-torsional eye movements in the plane of the left SSC induced by tones of 500-1,000 Hz at the 110-dB hearing level in the left ear. Dehiscence of bone overlaying the left SSC was confirmed at surgery. (a) Coronal 0.5-mm-collimated CT scan through the right temporal bone demonstrates an intact layer of bone (arrow) over the SSC. (b) Multiplanar reformation in an oblique sagittal orientation confirms the presence of an intact layer of bone (arrows) overlaying the right SSC. (c) Coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates dehiscence of bone (arrow) overlaying the left SSC. (d) Multiplanar reformation in an oblique sagittal orientation through the left temporal bone demonstrates an area of dehiscence (arrows) overlaying the left SSC.

View larger version (140K): [in a new window]   Figure 3d. Vertigo induced by loud noises in the left ear of a 37-year-old man. Clinical examination findings indicated vertical-torsional eye movements in the plane of the left SSC induced by tones of 500-1,000 Hz at the 110-dB hearing level in the left ear. Dehiscence of bone overlaying the left SSC was confirmed at surgery. (a) Coronal 0.5-mm-collimated CT scan through the right temporal bone demonstrates an intact layer of bone (arrow) over the SSC. (b) Multiplanar reformation in an oblique sagittal orientation confirms the presence of an intact layer of bone (arrows) overlaying the right SSC. (c) Coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates dehiscence of bone (arrow) overlaying the left SSC. (d) Multiplanar reformation in an oblique sagittal orientation through the left temporal bone demonstrates an area of dehiscence (arrows) overlaying the left SSC.

View larger version (135K): [in a new window]   Figure 4a. Symptoms of vertigo and dysequilibrium induced by loud noises or pressure in the left ear of a 57-year-old man. These symptoms began after an automobile accident in which the patient sustained a closed head injury with loss of consciousness and a cervical spine fracture. (a) Standard coronal 1.0-mm-collimated CT scan through the left temporal bone demonstrates a possible area of bone dehiscence (arrow) over the left SSC. (b) Oblique coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates intact bone (arrow) over the left SSC.

View larger version (130K): [in a new window]   Figure 4b. Symptoms of vertigo and dysequilibrium induced by loud noises or pressure in the left ear of a 57-year-old man. These symptoms began after an automobile accident in which the patient sustained a closed head injury with loss of consciousness and a cervical spine fracture. (a) Standard coronal 1.0-mm-collimated CT scan through the left temporal bone demonstrates a possible area of bone dehiscence (arrow) over the left SSC. (b) Oblique coronal 0.5-mm-collimated CT scan through the left temporal bone demonstrates intact bone (arrow) over the left SSC.