Cochlear Implants and SSCD Among Surgical Specialties
Superior semicircular canal dehiscence (SSCD) is a condition that has been termed as such in medical literature for only 20 years. “It’s a radiographic diagnosis of a bone missing over part of the superior semicircular canal,” says Joseph Breen, MD, assistant professor of otolaryngology‒head and neck surgery, University of Cincinnati Medical Center (UC Medical Center). SSCD and expanding criteria for cochlear implantation are two emerging areas that will receive increased emphasis with the addition of Dr. Breen.
“I’m involved in the entire breadth of otology and neurotology with my partners here,” says Dr. Breen. His partners include Ryan Collar, MD, and David Hom, MD, in treating facial-nerve disorders, and Ravi Samy, MD, in performing cochlear implants and lateral skull base surgery. Dr. Breen’s medical and surgical capabilities encompass all pathologies of the ear and the skull base, such as hearing loss, dizziness, chronic ear disease, lateral skull base tumors and other temporal bone disorders. “I’ve also been fortunate to have extensive exposure to cancer of the temporal bone in training,” says Dr. Breen. “It’s rare, but I’ll continue to develop expertise in this niche in my practice at UC Medical Center.”
Dr. Breen cites SSCD as a key challenge facing his specialty. “It’s a radiographic diagnosis, but the key to appropriate management is understanding the collection of associated symptoms in each individual patient,” says Dr. Breen. Patients with this condition may experience vertigo, autophony, hearing loss or a combination of vestibular and auditory symptoms. Dr. Breen says that physicians likely saw patients with symptoms of this condition in years past, but because patients vary in their presentation, and imaging techniques have advanced with time, SSCD was not recognized as a clinical entity until recently. “We’re still trying to understand which patients are surgical candidates, which symptoms we can fix and whether there are satisfactory nonsurgical treatments,” says Dr. Breen.
The primary surgical treatment for SSCD is “plugging or resurfacing the dehiscent canal through the mastoid or by a middle fossa craniotomy,” says Dr. Breen who anticipates doing at least five to 10 procedures annually. Given that UC Medical Center is a referral center, “we’ll be at the vanguard of finding and reporting outcomes” for conditions such as SSCD, in addition to providing care, Dr. Breen says.
An increasingly common procedure is cochlear implantation. Considered “almost experimental for bilaterally deaf individuals in the 1970s,” cochlear implantation is now being performed more frequently on people with lesser degrees of hearing loss or profound hearing loss in only one ear. “My senior partner, Dr. Rami Samy, is very interested in expanding the frontiers of cochlear implantation, and I look forward to partnering with him,” says Dr. Breen, who also believes that “surgeons are beginning to understand techniques that help to preserve residual natural hearing while providing the benefits of an implant in the same ear.”
Dr. Breen’s research goals include studying outcomes in patients with cochlear implants, SSCD surgeries and spinal fluid leak repairs. “Most of my research questions will be driven by what I think will benefit our patients,” he said.
Prior to receiving his UC Medical Center appointment in 2016, Dr. Breen was a neurotology fellow in the department of otolaryngology–head and neck surgery at Baylor College of Medicine, Houston, Texas. He received his medical degree from Northwestern University Feinberg School of Medicine with distinction in research, and completed a residency in otorhinolaryngology–head and neck surgery at Mayo Clinic, Rochester, Minn. Dr. Breen is a member of the American Academy of Otolaryngology–Head and Neck Surgery, a soon-to-be inducted associate member of the American Neurotology Society and a former board member of the Minnesota Academy of Otolaryngology.
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