Canal Occlusion Surgery for Intractable Benign Paroxysmal Positional Vertigo

Abstract

Benign paroxysmal positional vertigo (BPPV) usually resolves in the natural course. Furthermore, therapeutic maneuvers have been reported to accelerate its resolution. However, some patients are annoyed by persistent dizziness and positional nystagmus in their daily lives after conservative treatments, resulting in psychological problems. We have finally identified a surgical treatment strategy for such patients with intractable BPPV, i.e., canal occlusion or canal plugging surgery.We encountered a 28 year-old-man who was diagnosed as having posterior semicircular canal type BPPV, identified by 3 D-eye rotation axis analysis during Dix-Hallpike positioning. He had suffered from persistent positional vertigo for more than 10 years despite undergoing various kinds of non-surgical treatments. We performed posterior semicircular canal occlusion surgery for intractable BPPV in this patient, which resulted in successful resolution of the complaints and nystagmus. There were no significant side effects, including sensorineural hearing loss, after the operation.We would like to conclude that the safe and effective option of canal occlusion surgery should be considered for intractable BPPV, although such a condition is very rare (0.23% in our case series). We would also like to emphasize that 3 D-eye rotation axis analysis is quite helpful for identifying the affected semicircular canal in BPPV patients.