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.

STUDY DESIGN

Retrospective review.

SETTING

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.

OUTCOME MEASURES

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.