Surgical Treatment of Benign Paroxysmal Positional Vertigo

Abstract

Benign paroxysmal positional vertigo (BPPV) is a common condition most commonly caused by free-floating endolymph particles in the posterior semicircular canal. Well over 90% of patients can be successfully treated with the simple particle repositioning manoeuvre on an outpatient basis. A small percentage of patients have intractable, incapacitating, and multiply recurrent BPPV for whom surgical intervention should be considered. The singular neurectomy was introduced in the 1970s, but this has largely been replaced by the simpler posterior canal occlusion. A series of 48 ears having undergone posterior canal occlusion are presented as the largest series in the literature to date. All operated ears were relieved of BPPV, with one patient having a late recurrence. Of the 44 ears with normal preoperative hearing, one had a delayed (3-month) sudden and permanent profound loss, while another had a mild (20dB) loss. Six patients had protracted courses of imbalance and motion sensitivity. Both the history and technique of posterior canal occlusion are discussed in detail. Several studies have supported the safety and efficacy of this procedure. In most otology clinics, it has become the procedure of choice for intractable BPPV.

• posterior semicircular canal occlusion
• semicircular canal
• plugging
• occlusion
• benign paroxysmal positional vertigo
• BPPV
• surgical technique
• singular neurectomy
• review