Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988-2006).
OBJECTIVE
To assess the long-term efficacy and safety of posterior semicircular canal (PSCC) occlusion for intractable and incapacitating benign paroxysmal positional vertigo (BPPV) and identify lessons that may be learned from our experience.


METHODS
Retrospective review.


METHODS
Tertiary referral centre.


METHODS
Clinical records and results of audiometric and vestibular testing were reviewed on a series of patients who underwent occlusion of the PSCC for intractable BPPV between 1988 and 2006.


METHODS
Postoperative neurotologic examination, audiometry, and vestibular testing were assessed.


RESULTS
Thirty-two PSCC occlusion procedures were performed (24 females, 8 males; mean age 46 years). The average follow-up was 63 months. All patients had complete resolution of their PSCC positional vertigo, which has been maintained long term. Thirteen patients (40%) have experienced other forms of dizziness postoperatively (contralateral BPPV in four, continued Meniere disease attacks in three, ipsilateral lateral or superior canal BPPV in two, otolithic symptoms in two, continued oscillopsia in one, and subsequent cerebellar degeneration in one). Postoperative audiometry demonstrated an average reduction in pure-tone threshold of 6.1, 6.3, and 6.9 dB at 0.5 to 3, 4, and 8 kHz, respectively. Five patients had a mild to moderate reduction in caloric activity in the operated ear postoperatively. Two patients with Meniere disease had a significant postoperative caloric reduction. No patient had postoperative facial weakness.


CONCLUSIONS
PSCC occlusion is a safe and highly effective treatment for intractable BPPV. However, other forms of vertigo may persist or arise subsequently in approximately 40% of cases. Patients with Meniere disease may be susceptible to increased caloric reduction postoperatively.
Department of Otolaryngology, University Health Network, Toronto, Ontario.
Vitaly
V
Kisilevsky
Neil A
NA
Bailie
Sunil N
SN
Dutt
John A
JA
Rutka
D000328:Adult; D001301:Audiometry, Pure-Tone; D002150:Caloric Tests; D002531:Cerebellum / Q000503:physiopathology; D004584:Electronystagmography; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009410:Nerve Degeneration / Q000503:physiopathology; D013506:Otologic Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D012665:Semicircular Canals / Q000503:physiopathology* / Q000601:surgery*; D012720:Severity of Illness Index; D014717:Vertigo / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D014724:Vestibular Function Tests; D055815:Young Adult