The dehiscence of superior semicircular canal is a well-known affection which is able to explain some cases of hearing loss, tinnitus and/or vertigo unexpectedly presenting in adults without previous otologic affections. Although a diagnostic algorithm has been assessed and a surgical therapy has been indicated, the review of the literature shows that a completely satisfactory explanation for the reason why symptoms of a supposed congenital condition only occur in adulthood is still lacking. A pathogenic hypothesis based on the slow metabolism of the bony labyrinth, which could in time result in a prevalence of bone re-absorption on new bone formation leading to a dehiscence, despite some controversial findings could represent a the most reliable explanation for the question.