Common Symptoms of SCDS
Although it is commonly felt that SCDS patients always experience dizziness, many of these patients can experience ear fullness or hearing loss alone WITHOUT dizziness -
- Fullness of one or both ears - often a patient with SCDS will complain that the ear with the dehiscence feels blocked or full.
- Autophony - many patients complain that a "reverbation" or "echo" occurs in the problem ear(s) when talking or chewing or that one own's voice sounds louder in the affected ear. Patients will often state that they can hear their own heartbeat in the affected ear(s).
- Hearing loss - when present, often there will be a an air-bone gap type hearing loss, and sometimes the audiogram will show supranormal bone conduction thresholds.
- Dizziness - often the dizziness is triggered by loud, low frequency sounds or heavy lifting or straining.
IMPORTANT: SOME PATIENTS DO NOT HAVE SYMPTOMS BUT SSCD IS DISCOVERED INCIDENTALLY. PATIENTS WHO HAVE RADIOGRAPHIC EVIDENCE OF SSCD ON HIGH RESOLUTION CT SCANS BUT NO SPECIFIC SYMPTOMS THAT ARE REFERABLE TO THE SPECIFIC EAR ARE NOT CANDIDATES FOR SURGERY. SURGERY TO REPAIR SCD IN A PATIENT WITH NO SYMPTOMS IS NOT INDICATED AND CAN CAUSE MORE PROBLEMS SUCH AS DIZZINESS AND HEARING LOSS.
Common activities that can trigger dizziness and oscillopsia (eyes bouncing up and down) in SCDS:
- Heavy lifting
- Sexual activity
- Exposure to low frequency sounds
- Exposure to loud sounds
Minor and colleagues reported that 23% of patients reported a "second event" - a loud noise, lifting a heavy object, or sustaining a head trauma, that triggered the first symptoms of dizziness due to SCDS.
Watters and colleagues reported that 48% of patients who underwent surgical repair (implies that these were patients with severe symptoms) had a "second event" that precipitated their dizziness.
Unlike benign positional vertigo, which presents with rotatory vertigo in the horizontal plane, patients with SCDS will often describe a sensation of oscillopsia, or eyes "jumping up and down," or vertigo in the "vertical plane." The horizon will move up and down during the episode.
However, there is a great deal of variability with how SCDS patients present to their otolaryngologist or otologist.
Again, some patients have no vestibular or balance complaints, presenting only with conductive hearing loss. Often, we have seen patients who have been surgically explored for possible otosclerosis, only to find that the preoperative audiograms did not include a test of the stapedial, or acoustic reflex. In other cases, the reflex was present but the ear was explored to rule out other middle ear pathology. A stapedotomy or stapedectomy fails to correct the conductive hearing loss.