Clinical effect of canal plugging on paroxysmal positional vertigo

Abstract

A 63-year-old woman had disabling positional vertigo for four months. She showed intense direction-changing apogeotropic nystagmus. Conservative treatment failed to resolve her vertigo. From the findings of the nystagmus, cupulolithiasis of the right lateral canal was suspected. Plugging of this canal successfully eliminated the nystagmus and positional vertigo. Positional vertigo can sometimes be disabling and unresponsive to conservative therapy. Careful analysis of the nystagmus may allow selection of the most appropriate treatment.

Refractory Positional Vertigo With Apogeotropic Horizontal Nystagmus After Labyrinthitis

“…In the setting of refractory horizontal BPPV, surgical treatment has been described only twice in the medical literature and in both instances involved a canal occlusion procedure (16,17). Although a left horizontal semicircular canal occlusion procedure was considered, a transmastoid labyrinthectomy was preferable for several reasons.…”

Efficacy of physical therapy for intractable cupulolithiasis in an experimental model

“…Based on our experience, cases of intractable cupulolithiasis occur and can even require canal plugging surgery. 5 Therefore, the development of physical therapy with maximal efficacy for cupulolithiasis is highly desirable. Chiou et al 6 have reported the use of a forced prolonged position, wherein patients with cupulolithiasis were required to lie on the side of weaker nystagmus for 12 hours.…”

“…This type of vertigo could be explained by cupulolithiasis. Based on our experience, cases of intractable cupulolithiasis occur and can even require canal plugging surgery 5 . Therefore, the development of physical therapy with maximal efficacy for cupulolithiasis is highly desirable.…”

Morphological change of the cupula due to an ototoxic agent: A comparison with semicircular canal pathology

“…Furthermore, reduction of the cupula size also may explain why semicircular canal plugging becomes ineffective in some cases [14,15]. Even if the distal end of the semicircular canal is plugged, the closed space effect between the plugging site and the cupula is abolished due to the space between the cupula and ampullary wall, thus leading to swing-door cupula movement and nystagmus.…”