Dear Editor,

The authors sought to characterize the length of time to diagnosis of superior semicircular canal dehiscence (SSCD) and describe factors that may contribute to diagnostic delays at a single-institution, academic tertiary care center. Among 23 adults (>18 years old) with a diagnosis of SSCD between 2015 and 2020, the majority were female (78%), with an average age of 43 years. The average time between symptom onset and presentation was 1.7 years. The most common symptoms were hearing loss (57%), autophony (52%), and aural fullness (43%). The average time from presentation to correct diagnosis (confirmed by CT and VEMP testing) was 2.2 years. Prior to diagnosing SSCD, 13 patients (57%) received alternate diagnoses including Eustachian tube dysfunction, benign paroxysmal positional vertigo, Ménière’s disease, and otosclerosis. The average time between SSCD diagnosis and treatment was 10 months. Thirty-nine percent of patients were treated surgically (n = 9), and 35% (n = 8) were lost to follow-up after receiving their diagnosis.

It is important for physicians to remain sensitive to the prolonged history, multiple referrals, and other challenges faced by patients with SSCD. Most patients in this retrospective review went months to years without seeing a healthcare professional after self-reported onset of symptoms. SSCD can encompass a variety of presentations with differing degrees of severity [1]; thus, patients may not be inclined to be seen for mild symptoms that are not initially bothersome enough to address.

Providers in the primary care setting encounter a multitude of conditions on a regular basis, with otolaryngology complaints comprising 20–50% of the scope of a primary care practice [2]. However, the medical literature has indicated that otolaryngology experience among PCPs can be low, including uncertainty about the scope of practice of otolaryngology [3]. This, along with the ambiguous symptomology of SSCD, may contribute to prolonged timing for referral, an appropriate diagnostic workup, or initial alternate diagnoses. Our findings support the literature highlighting the importance of continuing medical education to enhance otolaryngology exposure among PCPs [4]. Educational opportunities could raise awareness of SSCD, especially in the setting of variable clinical presentations that make SSCD difficult to recognize without a high index of suspicion. Significant delays may still occur with the presentation to subspecialists, establishing the need to expand educational efforts to include subspecialists as well.

It is unknown whether the individuals who were lost to follow-up continued care elsewhere or chose to forego diagnostic evaluation and treatment altogether. Evidence suggests that lack of patient follow-up can occur not only due to wait times for appointments but also from lack of understanding that follow-up is needed [5]. Improving health literacy increases treatment adherence [6]; therefore, education efforts targeted toward the patients’ otologic symptoms and SSCD diagnostic testing may improve adherence with follow-up. The authors ultimately highlight that close follow-up and thorough patient education may be necessary to build trust and prevent loss to follow-up, which was high in this retrospective review.

The authors have no conflicts of interest to declare.

The authors received no funding sources for this research.

Sarah Benyo and Robert A. Saadi: concept design, analysis and interpretation of data, drafting and revisions of the letter to the editor, and agreement to be accountable for all aspects of this work. Huseyin Isildak: concept design, analysis and interpretation of data, final approval of the letter to the editor, and agreement to be held accountable for all aspects of this work.

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