KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD
VRABEC HAS written a concise review on benign paroxysmal positional vertigo (BPPV) and otolith repositioning.
Most clinicians believe that BPPV is typically caused by canalithiasis and, less commonly, cupulolithiasis. Most agree that various head repositioning maneuvers are effective in the majority of patients.
Nonetheless, there will be patients who present with atypical symptoms and cases that are refractory to common treatments. These situations may be due to secondary associated vestibulopathies, such as Ménière disease or central nervous system dysfunctions. Horizontal semicircular canal variants can be particularly difficult to treat. Unrelenting posterior canal vertigo can be effectively treated with canal occlusion surgery. In our experience, use of the carbon dioxide laser can enhance efficacy and minimize hearing loss. Although singular neurectomy can be an effective option, most surgeons currently favor canal occlusion surgery.
Kartush JM. Benign Paroxysmal Positional Vertigo and Otolith RepositioningTreatment Options and Unanswered Questions. Arch Otolaryngol Head Neck Surg. 1998;124(2):225-226. doi:10.1001/archotol.124.2.225