Transmastoid semicircular canal occlusion: A safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence

Abstract

The transmastoid approach to canal plugging is successful in the treatment of symptoms in both SSCD and intractable BPPV, and is a familiar approach for the otologist. This is a viable alternative to the middle fossa approach for SSCD, thereby avoiding a craniotomy. Transmastoid is the definitive approach for posterior canal occlusion.

Recent advances in superior semicircular canal dehiscence syndrome

“…This approach has been shown to be safe, effective and less invasive than the middle cranial fossa approach; it can be performed as a day-case operation. [35][36][37][38] There have also been a few reports of using a transcanal approach to round window occlusion, particularly to treat hyperacusis. [39][40][41] This remains an experimental form of management of this syndrome.…”

Benign paroxysmal positional vertigo: Diagnostic criteria

“…The hypothesis of canalolithiasis and cupulolithiasis is supported by in-vitro and in-vivo animal models [63,71], by mathematical models [33,40,65] and by the efficacy of specific canal clearing procedures [31,32,54] and plugging of the affected semicircular canal [10]. Furthermore, particulate matter within the posterior canal has been observed intraoperatively in patients with BPPV [64,80].…”

“…C. Positional nystagmus 8,9 compatible with canalolithiasis of more than one canal during the DixHallpike maneuver and the supine roll test. D. Not attributable to another disorder 10 .…”

Simultaneous, unilateral plugging of superior and posterior semicircular canal dehiscences to treat debilitating hyperacusis

“…The postoperative development of BPPV-like symptoms/findings in our patient was very surprising, given that plugging of PSC was shown to effectively treat intractable BPPV (11) . Possible explanations include cupulolithiasis or incomplete occlusion of the posterior canal.…”