Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T21:29:07.708Z Has data issue: false hasContentIssue false
  • English
  • Français

Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years

Published online by Cambridge University Press:  15 May 2012

R M Ahmed ,
D V Pohl ,
H G MacDougall ,
T Makeham  and
G M Halmagyi
R M Ahmed
Affiliation:
Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
D V Pohl
Affiliation:
Department of Otorhinolaryngology, Royal Prince Alfred Hospital, Sydney, Australia
H G MacDougall
Affiliation:
Vestibular Research Laboratory, School of Psychology, University of Sydney, New South Wales, Australia
T Makeham
Affiliation:
Department of Otorhinolaryngology, Royal Prince Alfred Hospital, Sydney, Australia
G M Halmagyi*
Affiliation:
Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
*
Address for correspondence: Dr G M Halmagyi, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia 2050 Fax: +61 2 9515 7564 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To report the outcome of posterior semicircular canal occlusion surgery for intractable benign positional vertigo, regarding vertigo cure rate and hearing and balance outcomes.

Methods:

Retrospective review of 53 patients presenting with benign positional vertigo, unresponsive to repositioning manoeuvres, who eventually underwent posterior canal occlusion, over a 20 year period.

Results:

From 1991 to 2011, 5364 benign positional vertigo patients were treated in our balance disorders clinic; 53 of those who failed to respond to repositioning underwent posterior canal occlusion. All 53 were cured of their benign positional vertigo. Nine suffered some symptomatic permanent hearing loss (>20 dB at low and >25 dB at high frequencies). Ten patients suffered caloric vestibular function deterioration, with mild but permanent subjective imbalance in five; a further 10 patients with no post-operative caloric test changes also had some permanent imbalance. Benign positional vertigo later developed in the operated ear lateral canal in two patients and in the opposite ear posterior canal in eight patients. Two patients needed bilateral sequential posterior canal occlusion.

Conclusion:

Posterior canal occlusion is a highly effective treatment for intractable benign positional vertigo, with what is probably an acceptable risk to hearing and balance: five of six patients will have no hearing problem and nine of 10 no balance problem after surgery.

Keywords

Ear, InnerBenign Positional VertigoOtologic Surgical Procedure
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 7 , July 2012 , pp. 677 - 682
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Parnes, LS, Agrawal, SK, Atlas, J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003;169:681–93Google ScholarPubMed
2Money, KE, Scott, JW. Functions of separate sensory receptors of nonauditory labyrinth of the cat. Am J Physiol 1962;202:1211–20CrossRefGoogle ScholarPubMed
3Epley, JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1980;88:599–605CrossRefGoogle ScholarPubMed
4Parnes, LS, McClure, JA. Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990;99:330–4CrossRefGoogle ScholarPubMed
5Parnes, LS, McClure, JA. Posterior semicircular canal occlusion in the normal hearing ear. Otolaryngol Head Neck Surg 1991;104:52–7CrossRefGoogle ScholarPubMed
6Pohl, DV. Surgery for benign positional vertigo. In: Baloh, RW, Halmagyi, GM, eds. Disorders of the Vestibular Sytem. New York: Oxford University Press, 1996Google Scholar
7Fife, TD, Iverson, DJ, Lempert, T, Furman, JM, Baloh, RW, Tusa, RJ et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence based review). Neurology 2008;70:2067–74CrossRefGoogle ScholarPubMed
8Helminski, JO, Zee, DS, Janssen, I, Hain, TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 2010;90:663–78CrossRefGoogle ScholarPubMed
9Aw, ST, Halmagyi, GM, Pohl, DV, Curthoys, IS, Yavor, RA, Todd, MJ. Compensation of the human vertical vestibulo-ocular reflex following occlusion of one vertical semi-circular canal is incomplete. Exp Brain Res 1995;103:471– 5CrossRefGoogle ScholarPubMed
10Cremer, PD, Halmagyi, GM, Aw, ST, Curthoys, IS, McGarvie, LA, Todd, MJ et al. Semicircular canal plane head impulses detect absent function of individual semicircular canals. Brain 1998;121:699–716CrossRefGoogle ScholarPubMed
11MacDougall, HG, Weber, KP, McGarvie, LA, Halmagyi, GM, Curthoys, IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 2009;73:1134–41CrossRefGoogle ScholarPubMed
12Halmagyi, GM, Yavor, RA, McGarvie, LA. Testing the vestibulo-ocular reflex. Adv Otorhinolaryngol 1997;53:132–54Google ScholarPubMed
13Halmagyi, GM, Curthoys, IS. A clinical sign of canal paresis. Arch Neurol 1988;45:737–9CrossRefGoogle ScholarPubMed
14Karlberg, M, Hall, K, Quickert, N, Hinson, J, Halmagyi, GM. What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol 2000;120:380–5Google ScholarPubMed
15Lee, NH, Ban, JH, Lee, KC, Kim, SM. Benign paroxysmal positional vertigo secondary to inner ear disease. Otolaryngol Head Neck Surg 2010;143:413–17CrossRefGoogle ScholarPubMed
16Millen, SJ, Schnurr, CM, Schnurr, BB. Vestibular migraine: perspectives of otology versus neurology. Otol Neurotol 2011;32:330–7CrossRefGoogle ScholarPubMed
17Cremer, PD, Migliaccio, AA, Pohl, DV, Curthoys, IS, Davies, L, Yavor, RA et al. Posterior semicircular canal nystagmus is conjugate and its axis is parallel to that of the canal. Neurology 2000;54:2016–20CrossRefGoogle ScholarPubMed
18Leveque, M, Labrousse, M, Seidermann, L, Chays, A. Surgical therapy in intractable benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2007;136:693–8CrossRefGoogle ScholarPubMed
19Agrawal, S, Parnes, L. Human experience with canal plugging. Ann N Y Acad Sci 2001;942:300–5CrossRefGoogle ScholarPubMed
20Kisilevsky, V, Bailie, NA, Dutt, SN, Rutka, JA. Lessons learned from the surgical management of benign paroxysmal positional vertigo: the university health network experience with posterior semicircular canal occlusion surgery (1988–2006). J Otolaryngol Head Neck Surg 2009;38:212–21Google ScholarPubMed
21Shaia, WT, Zappia, JJ, Bojrab, DI, LaRouere, ML, Sargent, EW, Diaz, RC. Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory. Otolaryngol Head Neck Surg 2006;134:424–30CrossRefGoogle ScholarPubMed
22Hawthorne, M, El-Naggar, M. Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo. J Laryngol Otol 1994;108:935–9CrossRefGoogle ScholarPubMed
23Walsh, RM, Bath, AP, Cullen, JR, Rutka, JA. Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Clin Otolaryngol 1990;24:316–23CrossRefGoogle Scholar
24Zappia, JJ. Posterior semicircular canal occlusion for benign paroxysmal positional vertigo. Am J Otol 1996;17:749–54Google ScholarPubMed
25Pace-Balzan, A, Rutka, JA. Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo. J Laryngol Otol 1991;105:901–6CrossRefGoogle ScholarPubMed
26Seo, T, Hashimoto, M, Saka, N, Sakagami, M. Hearing and vestibular functions after plugging surgery for the posterior semicircular canal. Acta Otolaryngol 2009;129:1148–52CrossRefGoogle ScholarPubMed
27Dingle, AF, Hawthorne, MR, Kumar, BU. Fenestration and occlusion of the posterior semicircular canal for benign positional vertigo. Clin Otolaryngol 1992;17:300–2CrossRefGoogle ScholarPubMed
28Halmagyi, GM, Weber, KP, Curthoys, IS. Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci 2010;28:33–42Google ScholarPubMed
29Gilchrist, DP, Curthoys, IS, Burgess, AM, Cartwright, AD, Jinnouchi, K, MacDougall, HG et al. Semicircular canal occlusion causes permanent VOR changes. Neuroreport 2000;11:2527–31CrossRefGoogle ScholarPubMed
30Yakushin, SB, Kolesnikova, OV, Cohen, B, Ogorodnikov, DA, Suzuki, J, Della Santina, CC et al. Complementary gain modifications of the cervico-ocular (COR) and angular vestibulo-ocular (aVOR) reflexes after canal plugging. Exp Brain Res 2011;210:549–60CrossRefGoogle ScholarPubMed
31Rabbitt, RD, Boyle, R, Highstein, SM. Physiology of the semicircular canals after surgical plugging. Ann N Y Acad Sci 2001;942:274–86CrossRefGoogle ScholarPubMed