title: Surgical therapy in intractable benign paroxysmal positional vertigo.
abstract: OBJECTIVE
  Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder. Although it is easily cured with canal repositioning maneuvers for the majority of patients, it can be disabling in rare cases. For these patients, surgical solutions may be proposed. The aim of this article is to review the techniques used, the reported cases in the literature, and to discuss their indication in intractable BPPV.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  All the articles from 1972 to 2005 that discussed a specific surgical therapy in BPPV were reviewed. Many of them reported cases of operated patients and described original techniques. Some others are anatomic studies that discussed the two techniques used: singular neurectomy and posterior semicircular canal occlusion.
  
  
  RESULTS
  Singular neurectomy (posterior ampullary nerve transsection) and posterior semicircular canal occlusion are the 2 specific techniques used in intractable BPPV surgery. The numbers of operated cases are 342 and 97, respectively. These small numbers indicate that the procedures are difficult and risk compromising hearing and that a very small population of patients require surgical treatment of BPPV. The operated cases have been decreasing since the early 1990s because of improved management in BPPV. This article summarizes the techniques and their results and proposes a currently recommended practice of surgical therapy in BPPV as well as new insights into intractable BPPVs' physiopathology.
authors.affiliation: Department of ENT, Robert Debre Hospital, CHU Reims, France. marilvq@aol.com
authors.forename: Marianne
authors.initials: M
authors.lastname: Leveque
authors.forename: Marc
authors.initials: M
authors.lastname: Labrousse
authors.forename: Laurent
authors.initials: L
authors.lastname: Seidermann
authors.forename: André
authors.initials: A
authors.lastname: Chays
mesh_terms: D006319:Hearing Loss, Sensorineural / Q000517:prevention & control; D006801:Humans; D013506:Otologic Surgical Procedures / Q000379:methods*; D004856:Postural Balance / Q000502:physiology*; D012665:Semicircular Canals / Q000503:physiopathology / Q000601:surgery; D014717:Vertigo / Q000503:physiopathology* / Q000601:surgery*; D014725:Vestibular Nerve / Q000601:surgery