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Response to Drs Carey et al

approach, and resulting vestibular function loss is generally only for the plugged SC and is well tolerated after a brief course of vestibular physical therapy. Not all patients found to have SCDS want or need surgical correction. Many are simply happy to have an explanation for their seemingly bizarre symptoms, like hearing their eyes move. But when patients are debilitated by frequent vertigo from loud sounds, by autophony or pulsatile tinnitus, or by constant disequilibrium from pulsating CSF moving fluid in the affected SC, surgery offers definitive relief. In summary, SCDS stands as one of the best scientifically supported diagnoses in otology. The third window hypothesis accurately explains the clinical observations in SCDS of elevated thresholds for perception of low-frequency airconducted sound and reduced thresholds for low-frequency bone-conducted sound. These concepts are richly supported by work in the chinchilla, and by clinical changes in airconducted sound and bone-conducted sound thresholds after superior canal dehiscence repair. The uncertainties of CT scans alone in diagnosing SCDS cannot be ignored, but these uncertainties do not justify an assault on the existence of the syndrome or the extraordinary clarity and elegant simplicity of the third window hypothesis.