Importance: Superior semicircular canal dehiscence (SSCD) is a treatable condition, but current diagnostic modalities have numerous limitations. Clinicians would benefit from an additional tool for diagnostic workup that is both rapid and widely available. Objective: To assess the utility of ambient pressure tympanometry (APT) in the diagnostic workup of SSCD by determining the sensitivity and specificity of APT for SSCD in comparison to other diagnostic modalities. Design: Retrospective cohort study of patients who underwent APT and temporal bone computerized tomography (CT) scans from May 2017 to July 2018. Setting: Tertiary referral center. Participants: APT was performed as part of routine audiological testing on adult patients. We retrospectively analyzed all patients who received both APT and temporal bone CT scans, and divided ears into SSCD and non-SSCD groups based on the presence or absence of radiographic SSCD. Ears with other radiographic findings that could affect tympanic membrane compliance were excluded. Exposures: All patients in this study underwent APT and temporal bone CT scans. Some patients also underwent pure tone audiometry and vestibular evoked myogenic potentials (VEMPs). Main Outcomes and Measures: The primary outcome measures were sensitivity, specificity, and risk ratio of APT for SSCD. Secondary outcome measures include sensitivity of VEMPs and supranormal hearing thresholds. Results: We describe 52 patients (70 ears) who underwent APT and CT imaging (mean age 47.1 years, 67.1% female). APT detected SSCD with 66.7% sensitivity and 72.1% specificity. In symptomatic patients, sensitivity was 71.4% and specificity was 75%. VEMPs performed best at detecting SSCD when defining a positive test as oVEMP amplitude >17 μV, with a sensitivity of 68.2%, similar to APT (p > 0.99). The combination of APT and VEMPs increased sensitivity to 88.9%, better than APT alone (p = 0.031) and trending toward better than VEMPs alone (p = 0.063). Conclusions and Relevance: Rhythmic wave patterns on APT are associated with SSCD and may raise suspicion for this condition in conjunction with consistent results on other diagnostic modalities. Although clinical utility requires confirmation in a larger prospective study, APT is a simple, rapid, and widely available tool warranting further study.

中文翻译：

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上半规管裂开患者的环境压力鼓室导抗测试波型。

重要性：上半规管裂开（SSCD）是一种可以治疗的疾病，但目前的诊断方式有许多局限性。临床医生将受益于快速且广泛使用的额外诊断检查工具。目的：通过确定 APT 与其他诊断方式相比对 SSCD 的敏感性和特异性，评估环境压力鼓室导抗测试 (APT) 在 SSCD 诊断检查中的效用。设计：对 2017 年 5 月至 2018 年 7 月接受 APT 和颞骨计算机断层扫描 (CT) 扫描的患者进行回顾性队列研究。地点：三级转诊中心。参与者：APT 是作为成年患者常规听力学测试的一部分进行的。我们回顾性分析了所有接受 APT 和颞骨 CT 扫描的患者，并根据是否存在放射学 SSCD 将耳朵分为 SSCD 组和非 SSCD 组。排除具有其他可能影响鼓膜顺应性的放射线检查结果的耳朵。暴露情况：本研究中的所有患者均接受了 APT 和颞骨 CT 扫描。一些患者还接受了纯音测听和前庭肌源性诱发电位（VEMP）检查。主要结果和测量：主要结果测量是 SSCD 的 APT 的敏感性、特异性和风险比。次要结果指标包括 VEMP 的敏感性和超正常听力阈值。结果：我们描述了 52 名接受 APT 和 CT 成像的患者（70 只耳朵）（平均年龄 47.1 岁，67.1% 为女性）。APT 检测 SSCD 的敏感性为 66.7%，特异性为 72.1%。在有症状的患者中，敏感性为 71.4%，特异性为 75%。当将阳性测试定义为 oVEMP 幅度 >17 μV 时，VEMP 在检测 SSCD 方面表现最佳，灵敏度为 68.2%，与 APT 类似 (p > 0.99)。APT 和 VEMP 的组合将敏感性提高到 88.9%，优于单独使用 APT (p = 0.031)，并且有优于单独使用 VEMP 的趋势 (p = 0.063)。结论和相关性：APT 的节律波模式与 SSCD 相关，结合其他诊断方式的一致结果，可能会引起对这种情况的怀疑。尽管临床实用性需要在更大规模的前瞻性研究中得到证实，但 APT 是一种简单、快速且广泛使用的工具，值得进一步研究。