Concierge neurotology · London
Semicircular canal plugging (SCDS) - London.
Definitive surgery for superior canal dehiscence syndrome. A consultant skull base and neurotology team closes the dehiscent superior semicircular canal through a small middle fossa craniotomy (or transmastoid approach), resolving autophony, Tullio phenomenon and pressure-induced vertigo.
What SCDS is
A "third window" in the inner ear.
Superior canal dehiscence syndrome (SCDS) is caused by thinning or absence of the thin plate of bone that should cover the superior semicircular canal at the roof of the petrous temporal bone.
Normally the labyrinth has two mobile windows onto the middle ear (oval and round). In SCDS the bony defect over the superior canal creates a pathological third window, letting sound and pressure energy escape into the vestibular system rather than driving the cochlea. The result is a distinctive cluster of symptoms: autophony (hearing your own voice, breathing, heartbeat or even eye movements uncomfortably loudly inside the head), Tullio phenomenon (vertigo and nystagmus provoked by loud sound), pressure-induced vertigo on Valsalva, sneezing or straining, pulsatile tinnitus, "hearing your own footsteps in your head" and conductive hyperacusis.
Audiometry often shows a low-frequency conductive hearing loss with intact reflexes, and bone conduction thresholds that are paradoxically better than normal. Many patients spend years being investigated for middle ear disease, migraine or functional dizziness before the diagnosis is made. Closing the third window surgically is the only definitive treatment.
Diagnosis
Symptoms plus imaging plus VEMP.
SCDS is a clinical diagnosis confirmed on dedicated imaging and vestibular physiology. All three pillars need to fit before surgery is considered.
High-resolution CT temporal bone
Sub-millimetre CT with dedicated Poschl (in-plane) and Stenvers (perpendicular) reconstructions to confirm true bony dehiscence over the superior semicircular canal, not just thinning.
Cervical VEMP
Cervical vestibular evoked myogenic potentials show a lowered threshold and increased amplitude on the affected side, the physiological signature of a third window.
Video-nystagmography
Loud sound and pressure stimulation with video-nystagmography can visibly reproduce torsional-vertical nystagmus in the plane of the superior canal, confirming the clinical Tullio phenomenon.
When surgery is indicated
Bothersome symptoms, not scans alone.
Radiographic dehiscence is found on CT in around 1 to 2 percent of the population, but most of those people are asymptomatic. Surgery is offered only where symptoms are significantly affecting quality of life.
Vertigo with sound or pressure
Recurrent Tullio phenomenon or pressure-induced vertigo that stops the person working, driving or exercising safely.
Intolerable autophony
Autophony severe enough that hearing your own voice, breathing or heartbeat inside the head is disabling in professional or social settings.
Progressive conductive hearing loss
Low-frequency conductive loss on audiometry with a normal tympanic membrane and stapes, attributable to the third window rather than middle ear disease.
Not incidental scan findings
Radiographic SCDS found by chance on a CT done for another reason, without matching symptoms and VEMP changes, does not warrant surgery.
Surgical approach
Middle fossa or transmastoid. Plug or resurface.
Two decisions frame the operation: how to reach the dehiscence, and how to close it. The MDT chooses based on anatomy, hearing status and surgeon experience.
Middle fossa craniotomy (preferred)
A small hair-sparing temporal craniotomy lifts the temporal lobe gently to expose the roof of the petrous bone. Gives the best direct view of the dehiscence and the highest control of the plugging, which is why most high-volume centres favour it.
Transmastoid approach
Less invasive, no craniotomy, no brain retraction. Access to the dehiscence is more limited, so it suits selected anatomies (e.g. posterior canal dehiscence, low-lying tegmen) and revision cases.
Plugging with fascia and bone dust
The bony canal is entered on either side of the dehiscence and the lumen is occluded with autologous temporalis fascia plus bone dust. Physically stops the third window and is the most durable option.
Resurfacing with fascia only
The defect is covered with fascia and bone paté without entering the canal lumen. Symptom relief can be less complete and revision rates are higher, but the canal function is preserved.
The procedure
One 3 to 4 hour operation, 3 to 5 nights in hospital.
Performed under general anaesthetic by a consultant skull base neurotology team with theatre neuromonitoring, using hair-sparing techniques where possible.
Admission is on the day of surgery. The temporal hair is trimmed sparingly along the incision line only. Under general anaesthetic, a small middle cranial fossa craniotomy is raised and the temporal lobe is gently elevated to expose the roof of the petrous bone. The superior semicircular canal dehiscence is identified under the operating microscope. The canal lumen is entered and packed with autologous temporalis fascia and bone dust, closing the third window. A layer of fascia and bone paté resurfaces the tegmen, the bone flap is replaced and the wound closed in layers. First night is on the neurosurgical high dependency unit, then 3 to 5 nights on the ward. Vestibular rehabilitation physiotherapy begins on day 2 to manage the transient dysequilibrium that follows disabling a canal.
Outcomes
What the published series show.
Figures from high-volume international neurotology series with middle fossa plugging. Results depend on operator volume and preoperative symptom pattern.
80-95%
Autophony resolution or major improvement.
80-90%
Resolution of sound- and pressure-induced vertigo.
<5%
Permanent sensorineural hearing loss after middle fossa plugging.
Weeks 1-4
Transient dysequilibrium common, settles with vestibular physiotherapy.
Indicative pricing
What private SCDS surgery costs in London.
All-inclusive private packages at our partner London skull base and neurotology units. Firm quote within one working day.
In short
Semicircular canal plugging in our London network: £22,000-£38,000 all-inclusive, home in 3-5 nights.
| Item | Indicative range | Stay |
|---|---|---|
| Neurotology consultation | £300-£500 | Outpatient |
| Workup (HRCT temporal bone, VEMP, audiogram, VNG) | £2,200-£3,800 | 5-10 days |
| Middle fossa plugging, standard case | £22,000-£30,000 | 3-4 nights |
| Middle fossa plugging, complex or revision | £28,000-£38,000 | 4-5 nights |
| Vestibular rehabilitation (6-12 sessions) | £900-£1,800 | Weeks 1-12 |
Prices vary by centre, surgeon and complexity. NHS SCDS surgery is available at tertiary skull base units. We check insurer cover before booking and pursue NHS access first where that fits better.
Where it is done in London
A small panel of London skull base units.
SCDS is rare and surgery should only be done at high-volume centres with joint neurotology and neurosurgical skull base input. We introduce you to the right team for your anatomy.
Royal National ENT Skull Base Unit (private)
National referral neurotology and lateral skull base service with combined ENT and neurosurgical operating for SCDS.
University College London Hospital ENT Neuro-otology (private)
Neuro-otology service at UCLH with vestibular physiology, dedicated CT and MRI reporting and skull base operating.
King’s Private ENT
Specialist ENT and skull base service at King’s College Hospital, with joint neurosurgical operating for middle fossa cases.
Great Ormond Street International Private (paediatric)
Paediatric neurotology and skull base service for the rare cases of childhood SCDS.
Private neurotologists via ENT UK
A short panel of ENT UK skull base neurotologists operating privately at London consultant-only hospitals.
Related
Related audio-vestibular services.
Vestibular rehabilitation
Physiotherapy for dizziness and balance.
Learn moreBone anchored hearing aid
BAHA implants for conductive loss.
Learn moreCochlear implant mapping
Programming and follow-up.
Learn morePrivate hearing aid fitting
Audiology fitting and aftercare.
Learn moreTilt table test
For syncope and postural symptoms.
Learn more
Frequently asked
Everything patients ask about SCDS surgery.
Quick answers on durability, hearing risk, insurer cover, bilateral disease, recovery and physiotherapy.
Is SCDS surgery permanent?
Yes. Plugging the canal with fascia and bone dust closes the third window permanently. Autophony resolves in 80 to 95 percent and vertigo triggered by sound or pressure resolves in 80 to 90 percent, sustained at 5 to 10 year follow-up.
What is the risk to hearing?
A small permanent sensorineural hearing loss occurs in under 5 percent after middle fossa plugging. The conductive loss caused by the dehiscence itself usually improves. Audiograms at baseline, 6 weeks and 3 months track this.
Do UK insurers cover it?
Most major UK insurers (Bupa, AXA Health, Vitality, Aviva, WPA, Cigna) cover SCDS surgery where diagnosis is confirmed on CT and VEMP, symptoms are bothersome and the case has been discussed at a neurotology MDT. Pre-authorisation is essential.
Can both ears be operated on?
Bilateral dehiscence is present in around a quarter on imaging, but only one ear is operated at a time. The more symptomatic side is treated first, with at least 6 to 12 months before the second is considered, and only if it remains bothersome.
How long is recovery?
Hospital stay is 3 to 5 nights. Transient dysequilibrium is common in weeks 1 to 4 and eases with vestibular physiotherapy. Most patients are back to desk work at 4 to 6 weeks, driving from 6 weeks (subject to DVLA rules) and full activity including exercise at 8 to 12 weeks.
Is vestibular physiotherapy required?
Yes. Structured vestibular rehabilitation from day 2 accelerates central compensation for the plugged canal and shortens dysequilibrium. Most patients complete 6 to 12 weekly sessions with a specialist vestibular physiotherapist.
Ready when you are
Send the details. We come back within one working day.
Symptoms, HRCT temporal bone report, VEMP and audiogram if you have them, and any prior ear surgery. We review, discuss at a neurotology MDT and come back with two or three London options, an indicative price and insurer cover confirmed.