By Marcello Cherchi, MD PhD
For patients
Different surgeries have been tried to help patients with benign paroxysmal positional vertigo, (BPPV) but they have some risks and may not work. We generally do not recommend surgery to treat BPPV.
For clinicians
A variety of essentially destructive procedures have been attempted by otolaryngologists in the management of benign paroxysmal positional vertigo (BPPV).
Of the surgical procedures attempted for management of BPPV the most common is “canal plugging,” first reported by Lorne Parnes and Joseph McClure (Parnes and McClure 1990). In this procedure the surgeon fills the semicircular canal affected by BPPV with either bone pâté or a synthetic substance. The logic of this procedure is that plugging the affected canal “silences” it, because otoliths can no longer enter it. Subsequent studies (Shaia, Zappia et al. 2006) reported impressive success with this procedure, but it was soon realized (Kisilevsky, Bailie et al. 2009) that potential complications of the procedure included hearing loss, vestibular deficits on objective testing, and even continued dizziness. The continued dizziness was particularly concerning, since that was the symptom the procedure was intended to treat. Among other problems, it was eventually recognized (Luryi, Schutt et al. 2018) that although plugging one canal might “silence” that canal, there remain five other semicircular canals that are still susceptible to developing BPPV.
A less commonly attempted surgical procedure for management of BPPV is cutting the nerve that transmits balance signals from the ear to the brain (which procedure is called “vestibular neurectomy”) or, if possible, cutting just the part of that nerve that transmits balance signals from the affected canal (which procedure is called “singular neurectomy” (Gacek 1978)). While the latter procedure (singular neurectomy) appeared promising and minimally destructive, it also turned out to be technically challenging, and few surgeons attempted it.
Taking these factors into consideration, we generally do not recommend surgery as a treatment for patients with BPPV.
References
Gacek, R. R. (1978). “Posterior ampullary nerve transection for benign paroxysmal positional vertigo.” Trans Pa Acad Ophthalmol Otolaryngol 31(2): 190-193.
Kisilevsky, V., N. A. Bailie, S. N. Dutt and J. A. Rutka (2009). “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 38(2): 212-221.
Luryi, A. L., C. A. Schutt, D. I. Bojrab, M. LaRouere, J. Zappia, E. W. Sargent and S. Babu (2018). “Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo.” Otol Neurotol 39(10): e1078-e1083.
Parnes, L. S. and J. A. McClure (1990). “Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo.” Ann Otol Rhinol Laryngol 99(5 Pt 1): 330-334.
Shaia, W. T., J. J. Zappia, D. I. Bojrab, M. L. LaRouere, E. W. Sargent and R. C. Diaz (2006). “Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory.” Otolaryngol Head Neck Surg 134(3): 424-430.
