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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.

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Those 27-month results demonstrate the validity of our UNHS program, which relies on the cooperation with maternities, an easy protocol and a strong follow-up procedure.

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Tinnitus is a public health issue in France. Around 1% of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We are reporting on the surgical treatment by electrical stimulation of the auditory cortex of a female patient affected by disabling tinnitus that resisted classical treatments. The tinnitus appeared suddenly 10 years ago after a left ear tympanoplasty. The acouphenometry measures revealed a bilateral tinnitus, predominant on the right side, constant, with high frequency (6000 Hz). Transcranial magnetic stimulation (TMS) was performed at first with several supraliminal and infraliminal protocols. This showed promising results. Anatomic and functional magnetic resonance imaging (fMRI) of the auditory cortex before and after repetitive TMS (rTMS) demonstrated a modification of the cortical activity and where the ideal location for a cortical electrode might be, to straddle primary and secondary auditory cortex. After these investigations, two quadra polar electrodes (Resume, Medtronic Ltd, Hertfordshire, UK), connected to a stimulating device implanted under the skin (Synergy, Medtronic Ltd), were extradurally implanted. The surgical procedure was similar to the one performed for analgesic cortical stimulation. No surgical complications were reported. The activation of the stimulator provided a reduction of 65% of the tinnitus impact, with a persistent effect on the right side. The feasibility of the cortical stimulation in symptomatic treatment of tinnitus was proven by this preparatory work. The middle-and long-term therapeutic effects remain to be evaluated. Ó 2009 Elsevier Inc. All rights reserved.Keywords tinnitus; auditive cortex; electric stimulation; transcranial magnetic stimulation Tinnitus is a public health issue in France, with around 1% of the population affected and 30,000 people handicapped in their daily life.Available treatments have been disappointing for disabling tinnitus. The treatment is delicate because of the psychological and behavioral repercussions of tinnitus, which leads many physicians to wonder about the organic origin of tinnitus. However, several neuroscience case studies have demonstrated the credibility of this symptom as a peculiar entity. In particular, the relationship between tinnitus and cerebral metabolic activity. 1

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