Initial Experience With Robotic-Assisted Otologic and Lateral Skull Base Surgery.

Robotic-assisted surgery has gained popularity for otolaryngology procedures. It provides high-definition images and surgical precision to perform diverse procedures. It is an alternative to the operating microscope, endoscope, or exoscope when reaching hidden anatomical structures in the ear. In this proof-of-concept study, we aim to demonstrate the possibility of using a robotic-assisted device to perform ear surgery in conjunction with the microscope or the endoscope. In total, there were 9 ear and lateral skull base procedures performed with the use of robotic-assisted surgery. All surgeons underwent surveys to assess the performance and workload of the device compared to the microscope or endoscope. There were no postoperative complications. Robotic-assisted surgery was optimal for providing high image quality, ergonomics, and maintaining surgical performance. The size of the device and mental demand were higher compared to the microscope or endoscope. Robotic-assisted surgery can be an adjuvant to perform otologic and neurotologic surgery.

Low-Lying Tegmen and Surgical Outcomes Following the Middle Cranial Fossa Repair of Superior Canal Dehiscence.

OBJECTIVE: To compare treatment response from the middle cranial fossa repair of superior canal dehiscence (SCD) between cases with and cases without low-lying tegmen (LLT). STUDY DESIGN: Cohort study. SETTING: Single tertiary care institution. METHODS: Two investigators independently reviewed preoperative high-resolution temporal bone computed tomography images and classified the ipsilateral tegmen as either "low-lying" or "control." Patients completed a symptom questionnaire and underwent audiometric testing pre- and post-operatively. Multivariable regression models assessed for symptomatic resolution and audiometric improvement following surgery with tegmen status as the primary predictor. Models controlled for patient age, sex, bilateral SCD disease, dehiscence location, prior ear surgery status, surgery duration, and follow-up duration. RESULTS: Among a total of 410 cases included, we identified 121 (29.5%) LLT cases. Accounting for all control measures, patients with LLT were significantly less likely to experience overall symptom improvement (adjusted odds ratio: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < .001) and reported a significantly lower proportion of preoperative symptoms that resolved following surgery (adjusted ß: -25.6%, 95% CI: -37.0% to -14.3%, p < .001). However, audiometric outcomes following surgery did not differ significantly between patients with and patients without LLT. CONCLUSION: This is the first investigation on the relationship between LLT and surgical outcomes following the middle fossa repair of SCD. Patients with LLT reported less favorable symptomatic response but exhibited a similar degree of audiometric improvement.

Educational Benefit of the Three-Dimensional Exoscope Versus Operating Microscope in Otologic Surgery.

OBJECTIVE: To compare observation of otologic surgery using a traditional operating microscope (OM) and a three-dimensional exoscope. STUDY DESIGN: Prospective, nonrandomized, noncontrolled study. SETTING: Tertiary care center. METHODS: Senior medical students and otolaryngology trainees observing otologic surgery performed with OM and exoscope were asked to complete a questionnaire comparing the two experiences. The key variables were image clarity, depth perception, observer's level of motion sickness during the surgery, the participant's understanding of middle ear anatomy, and their overall preference between OM and exoscope. RESULTS: Twenty-two observers participated in the study. Subjective clarity of the image was significantly better with the exoscope compared with the OM (9.7 ± 0.6 versus 6.9 ± 1.7, p = 0.0004) as well as the depth perception (9.25 ± 0.87 versus 5 ± 2.69, p = 0.0007). Observers subjectively had an improved understanding of middle ear anatomy after observing an exoscopic surgery, but not a microscopic surgery. All but one observer preferred the exoscope. CONCLUSION: The three-dimensional exoscope may be a valuable educational tool for teaching trainees otologic surgery. More objective studies are needed in the future to assess the degree of improvement.

Intralabyrinthine schwannoma: Surgical management and cochlear lumen preservation.

The present video reports the surgical removal of an intralabyrinthine schwannoma. The video contains patient's medical history, preoperative radiological evaluations and detailed description of surgical steps of the procedure, consisting in labyrinthectomy, cochleostomy and insertion of a dummy electrode in the preserved cochlear lumen within the context of a subtotal petrosectomy.

[Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap].

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

[Experiences with endoscopic ear surgery of a German tertiary hospital for otolaryngology]. / Erfahrungen mit der endoskopischen Ohrchirurgie an einer deutschen Hals­, Nasen­, Ohrenklinik der Maximalversorgung.

BACKGROUND: The aim of this article is to report on the integration of endoscopic ear surgery (EES) into daily clinical practice. MATERIAL AND METHODS: In a monocentric prospective study, the endoscopy unit was set up during even weeks over a period of 10 months and the procedure was primarily started endoscopically via a transmeatal approach. In odd weeks, the endoscopy was omitted. A total of 60 procedures in 59 patients were evaluated. Points of comparison were intraoperative vision, incision-suture time, postoperative hearing outcome, and postoperative otoscopic findings. RESULTS: With the exception of the facial nerve (p = 0.15 Mann-Whitney U­test), the EES showed significantly improved visualization of all areas in the middle ear. The incision-suture times were similar in both methods. If bimanual placement of an ossicular prosthesis was necessary, the incision-suture time increased disproportionately (MES: 57.18 ± 9.7 min, EES: 76.83 ± 24.99 min; p = 0.019, *). There were no statistically significant changes related to hearing outcomes when comparing EES with the microscopic technique. There were no postoperative complications in the EES surgery group. CONCLUSION: Integration of EES proved to be successful and advantageous in a real patient collective at this location.

Management of a Posterior Mesotympanic Cholesteatoma using the Transcanal Endoscopic Approach.

With the constant evolution in the role of endoscopy in middle ear surgery, this article presents a technical note on the transcanal endoscopic approach to resection of a cholesteatoma limited to the posterior mesotympanum. We believe that this technique provides a suitable, minimal-invasive alternative to the classic microscopic transmastoid approach.

Training in Endoscopic Ear Surgery: A Scoping Review.

OBJECTIVE: Despite the increasing popularity of Endoscopic Ear Surgery (EES), there is a lack of evidence to guide trainees as they introduce EES into practice. This review aims to evaluate training in EES including the optimal introductory procedures, methods of training, the learning curve, and the determination of competency in EES. In addition, this review seeks to identify any areas falling within these themes requiring further clarification. DATA SOURCES: A database search of Pubmed, Embase and the Cochrane Library was conducted in June 2022. Original articles, systematic reviews, and meta-analyses reporting on training in EES, introduction into practice, learning curves, and competency assessment were included. REVIEW METHODS: A scoping review was carried out in accordance with the Joanna Briggs Institute guidelines and reported according to PRISMA guidelines for scoping reviews. A qualitative assessment of results grouped thematically was performed. RESULTS: Twenty-eight studies met the inclusion criteria, with 24 rating as "fair" or "good" on quality assessment. Surgical simulation was the most frequently described method of training as utilized in 11 studies. The most suggested introductory procedure was tympanoplasty which was advocated for in five studies. Heterogeneity existed in the outcomes and methodologies used to measure EES learning curves, with an overreliance on surgical times. No robust definition of competency in EES procedures exists at present. CONCLUSIONS: Surgical simulation appears to be a beneficial training methodology for EES. However, there is a marked lack of objective data to describe the optimal introductory procedures or assessment of competency in EES. Laryngoscope, 133:3269-3278, 2023.

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery.

OBJECTIVES: This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized. DESIGN: Cross-sectional study. SETTING: Tertiary referral hospital. METHODS: A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports. RESULTS: Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A. CONCLUSION: Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.

Assessment of jugular bulb variability based on 3D surface models: quantitative measurements and surgical implications.

PURPOSE: High-riding jugular bulbs (JBs) among other anatomical variations can limit surgical access during lateral skull base surgery or middle ear surgery and must be carefully assessed preoperatively. We reconstruct 3D surface models to evaluate recent JB classification systems and assess the variability in the JB and surrounding structures. METHODS: 3D surface models were reconstructed from 46 temporal bones from computed tomography scans. Two independent raters visually assessed the height of the JB in the 3D models. Distances between the round window and the JB dome were measured to evaluate the spacing of this area. Additional distances between landmarks on surrounding structures were measured and statistically analyzed to describe the anatomical variability between and within subjects. RESULTS: The visual classification revealed that 30% of the specimens had no JB, 63% a low JB, and 7% a high-riding JB. The measured mean distance from the round window to the jugular bulb ranges between 3.22 ± 0.97 mm and 10.34 ± 1.41 mm. The distance measurement (error rate 5%) was more accurate than the visual classification (error rate 15%). The variability of the JB was higher than for the surrounding structures. No systematic laterality was found for any structure. CONCLUSION: Qualitative analysis in 3D models can contribute to a better spatial orientation in the lateral skull base and, thereby, have important implications during planning of middle ear and lateral skull base surgery.

An early report of exoscope-assisted otologic surgery.

BACKGROUND: Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution. METHODS: Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed. RESULTS: Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty. CONCLUSION: Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients.

OBJECTIVE: To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach. STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic referral center. METHODS: All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed. RESULTS: Thirty-five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6-month follow-up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey (P < .01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others (P = .04). Females reported higher cosmetic scores than males (P = .04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease. CONCLUSIONS: Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas.

Comparison of artefact reduction possibilities with the new active transcutaneous bone conduction implant (Bonebridge).

OBJECTIVE: This study aimed to evaluate the possibilities of artefact reduction using different anatomical implant positions with the Bonebridge bone-conduction hearing implant 602 for a patient with an acoustic neuroma requiring regular diagnostic magnetic resonance imaging of the tumour position. METHOD: Three implant positions and magnetic resonance imaging examinations with and without customised sequences for metal artefact suppression were investigated. The diagnostic usefulness was rated by a radiologist (qualitative evaluation), and the relation between the area of artefact and the total head area was calculated (quantitative evaluation). RESULTS: Following the qualitative analysis, the radiologist rated the superior to middle fossa implant placement significantly better for diagnostic purposes, which is in agreement with the calculated artefact ratio (p < 0.0001). The customised slice-encoding metal artifact correction view-angle tilting metal artifact reduction technique sequences significantly decreased the relative artefact area between 5.13 per cent and 25.02 per cent. The smallest mean artefact diameter was found for the superior to middle fossa position with 6.80 ± 1.30 cm (range: 5.42-9.74 cm; reduction of 18.65 per cent). CONCLUSION: The application of artefact reduction sequencing and special anatomical implant positioning allows regular magnetic resonance imaging in patients with the bone-conduction hearing implant 602 without sacrificing diagnostic imaging quality for tumour diagnosis.

Comparison of endoscopic vs microscopic ossiculoplasty: a study of 157 consecutive cases.

PURPOSE: The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery. MATERIALS AND METHODS: Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. RESULTS: Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. CONCLUSION: TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.

An endoscopic hydro-mastoidectomy technique for cholesteatoma surgery.

OBJECTIVE: Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It was hypothesised that endoscopic hydro-mastoidectomy might take less time than endoscopic non-underwater mastoidectomy because the endoscope does not need to be removed for cleaning. METHODS: This study compared the mastoidectomy and total operative durations between the endoscopic hydro-mastoidectomy (n = 25) and endoscopic non-underwater drilling (control, n = 8) groups. Moreover, it compared the size of resected areas of the external auditory canal between the two groups. RESULTS: The mastoidectomy time of the endoscopic hydro-mastoidectomy group was significantly shorter than that of the control group (p < 0.01). The total operative time did not differ significantly between the endoscopic hydro-mastoidectomy and control groups (p = 0.17). The resected area was significantly larger in the endoscopic hydro-mastoidectomy group than in the control group (p < 0.05). CONCLUSION: Endoscopic hydro-mastoidectomy enables more extensive bone resection within a shorter period.

A novel imaging scoring method for identifying facial canal dehiscence: an ultra-high-resolution CT study.

OBJECTIVES: Facial canal dehiscence (FCD), typically found in the tympanic segment, is a risk factor for facial nerve injury. An imaging scoring method was proposed to identify FCD based on ultra-high-resolution CT. METHODS: Forty patients (21 females and 19 males, mean age 44.3 ± 17.4 years), whose tympanic facial canal (FC) was examined during otological surgery, were divided into the FCD group (n = 29) and the control group (n = 11) based on surgical findings. Imaging appearance of tympanic FC was scored 0-3: 0 = no evident bony covering, 1 = discontinuous bony covering with linear deficiency, 2 = discontinuous bony covering with dotted deficiency, and 3 = continuous bony covering. Both lateral and inferior walls were assigned a score as LFCD and IFCD, respectively. An FCD score was calculated as LFCD + IFCD. The diagnostic value of the FCD score was tested using the ROC curve. RESULTS: The inter-observer agreement was moderate for the lateral wall (Cohen's κ coefficient 0.416, 95% CI 0.193-0.639), and good for the inferior wall (Cohen's κ coefficient 0.702, 95% CI 0.516-0.888). In the FCD group, the most common appearance for both walls was discontinuous bony covering with linear deficiency (LFCD = 1, 22/29, 75.9%; IFCD = 1, 15/29, 51.7%). An FCD score of less than 4 was associated with high sensitivity (0.82) and specificity (0.93) for identifying FCD, with an AUC of 0.928. CONCLUSIONS: Using the proposed scoring method, FCD score < 4 could identify FCD of the tympanic segment with high concordance with surgical findings. KEY POINTS: • Imaging appearance of the tympanic facial canal (FC) is divided into four types based on ultra-high-resolution CT images. • The most common appearance of FC with facial canal dehiscence (FCD) is discontinuous bony covering with linear deficiency. • An FCD score, consisting of scores of the lateral and inferior walls, less than 4 is highly indicative of FCD.

Updates in paediatric cholesteatoma.

PURPOSE OF REVIEW: The management of paediatric patients with cholesteatoma is complex, as the disease process is more aggressive in children than adults. New technologies and practice adaptations currently help optimize the surgical management and monitoring of these challenging patients. RECENT FINDINGS: Several options of surgical management are available and are associated with equal if not improved outcomes. Technologic advancements in endoscopic ear surgery, the discovery of chemical-assisted dissection of cholesteatoma and advanced imaging protocols have enabled surgeons to better care for patients with this complex disease process. SUMMARY: The advances in endoscopic ear surgery, the discovery of Mesna as a chemically assisted dissection agent to improve recidivism rates and the use of specific diffusion-weighted MRI protocols enable the otologic surgeon to better care for these paediatric patients.

Treatment results for congenital cholesteatoma using transcanal endoscopic ear surgery.

PURPOSE: Transcanal endoscopic ear surgery for congenital cholesteatoma provides a smaller incision and better visibility than conventional surgical microscope ear surgery. We aimed to evaluate the treatment results of transcanal endoscopic ear surgery in ameliorating the recurrence and post-operative complications of pediatric congenital cholesteatoma. MATERIALS AND METHODS: A retrospective chart review was conducted on patients with congenital cholesteatoma who underwent transcanal endoscopic ear surgery at a tertiary referral medical center from January 2012 to December 2020. We categorized the patients into two groups according to the presence of remnant cholesteatoma and compared their characteristics. RESULTS: This study included 46 patients (32 males and 14 females; 46 ears). The mean age was 3.0 ± 2.6 (1-17) years. Congenital cholesteatoma was predominantly located in the anterior-superior quadrant (63.0 %), and ossicular involvement was confirmed in six cases. The mean cholesteatoma size identified by temporal bone computed tomography was 3.9 ± 2.0 (1.2-13) mm. Seven cases had remnant cholesteatoma lesions (15.2 %); four improved after revision surgery, and three were followed up without immediate further intervention. Postoperative complications (e.g., tympanic membrane perforation, retraction) were observed in 10 cases. Comparative evaluations of various characteristics after categorizing the participants into residual and non-residual lesion groups revealed no significant differences. CONCLUSIONS: Consequently, transcanal endoscopic ear surgery can be considered an effective and safe operation for treating congenital cholesteatoma in the pediatric population with no serious side effects. Further large-scale research with hearing test results should be conducted meticulously as a follow-up to this study.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients.

BACKGROUND AND OBJECTIVE: Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarise its key points through a case series. MATERIALS AND METHODS: Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS: Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (±21.9). Four tumours were in the left ear and 2 in the right ear. These included four tympanic paragangliomas (three type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS: The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome.

OBJECTIVE: To report long-term patient reported outcome measures (PROMs) after standardized round window rein-forcement (RWR) with thin cartilage and perichondrium for superior semicircular canal dehiscence syndrome (SSCDS). METHODS: Cross-sectional survey in 2020 and retrospective longitudinal study of outcomes at 3 months, 1 year, and last follow-up after 28 consecutive RWRs. Endpoints were the last follow-up for PROMs and 1 year postoperatively for audiometry and cVEMP. RESULTS: At the last follow-up (mean 2.4 years postoperatively), improvement was reported for 19/28 ears (68%) in symptoms overall; for 17/27 ears (63%) in auditory symptoms, and for 12/24 (50%) in vestibular symptoms. Nine ears (32%) required further surgery. No major complications occurred. On the group level, postoperative improvement at 3 months declined significantly for auditory and vestibular symptoms over time, and stayed stable beyond 1 year. Improved ears had on average 2.9 years follow-up. Improvement correlated significantly with SSCD length, and was associated with contralateral dehiscence. Thirteen ears (46%) had another potential cause of vestibular symptoms. This group showed significantly less improvement. Audiometric test results did not predict PROMs. CONCLUSIONS: Since long-term outcomes do not compare with those reported for plugging and repair, RWR is not suggested as a first line intervention for SSCDS. Considering the stable rates of improvement on average 2.9 years postoperatively and the absence of major complications, RWR may be an alternative to plugging or repair in fragile patients who do not accept the risk of complications with more invasive surgery, and who accept that results may deteriorate over time.