Improvement in Autophony Symptoms After Superior Canal Dehiscence Repair

Objective: Autophony, or the unusually loud or disturbing sound of a patient's own voice, can be a prominent and disabling symptom of superior canal dehiscence (SCD) syndrome. The current study measures autophony symptoms before and after SCD plugging to quantify the benefits of surgery. Study Design: Patients undergoing SCD plugging between September 2007 and October 2008 completed a questionnaire before and 3 months after surgery. The questionnaire consisted of 26 statements to assess the disability caused by the sound of the patient's own voice. Patients graded each item on a scale from 0 (never) to 4 (almost always) to how often they noted a symptom or experience. Typical statements included "hearing my voice has interfered with my ability to work" and "hearing my voice has caused me to avoid social situations." An autophony index (AI) was generated to grade patient symptoms. Setting: Tertiary referral center. Patients: Nineteen adults with SCD. Intervention: Superior canal dehiscence plugging via a middle fossa approach. Outcome Measures: Change in AI. Results: Preoperatively, the mean AI was 42 +/- 27 (mean +/- SD; range, 0-86; 1 patient had no autophony symptoms). Postoperative AI decreased 89% to 9 +/- 22, a significant (p < 0.01) decline. Of the 18 patients with preoperative autophony, 13 had complete postoperative resolution. In 3 remaining patients, the AI decreased but did not resolve. One of these had bilateral SCD with contralateral autophony. One patient's mild autophony remained unchanged, and another patient with coexisting patulous eustachian tube AI increased after SCD plugging. Conclusion: In patients with significant autophony symptoms, SCD plugging improved 94% of patients. A simple 5-item AI is provided that will be useful in grading autophony symptoms.