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Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence.
Am J Otolaryngol 2018 Nov - Dec; 39(6):796-799AJ

Abstract

OBJECTIVE

Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD.

METHOD

This case report presents an adult with residual dizziness following surgical management of SSCD and vestibular rehabilitation therapy (VRT). During subsequent evaluation of vestibular function, a transient and torsional, down-beating nystagmus was provoked along with vertigo during Dix-Hallpike positioning to the right. This was consistent with BPPV affecting the left superior (anterior) semicircular canal.

RESULTS

The patient was treated with a repositioning maneuver to manage anterior semicircular canal BPPV and no nystagmus response was recorded with post-repositioning Dix-Hallpike test. Review of radiographic images, obtained prior to vestibular function testing, showed a hyperintensity in the area of the left anterior semicircular canal ampulla. It was felt this was likely a bone chip from the SSCD repair that was pushing against the ampulla with further mobile debris within the canal.

CONCLUSION

It is reported that BPPV is a common complication in patients surgically managed for SSCD. Posterior semicircular canal BPPV is reported most often, with a couple of cases of lateral semicircular canal BPPV also reported. As far as we are aware, the current case represents the first report of anterior semicircular canal BPPV in this type of patient.

Authors+Show Affiliations

Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Division of Vestibular Sciences, Nashville, TN, USA. Electronic address: richard.a.roberts@vanderbilt.edu.Vanderbilt University Medical Center, Department of Otolaryngology - Head and Neck Surgery, Nashville, TN, USA.Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Division of Vestibular Sciences, Nashville, TN, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30224218

Citation

Roberts, Richard A., et al. "Anterior Canal Benign Paroxysmal Positional Vertigo Following Surgical Management of Superior Canal Dehiscence." American Journal of Otolaryngology, vol. 39, no. 6, 2018, pp. 796-799.
Roberts RA, Rivas A, Makowiec KF. Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence. Am J Otolaryngol. 2018;39(6):796-799.
Roberts, R. A., Rivas, A., & Makowiec, K. F. (2018). Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence. American Journal of Otolaryngology, 39(6), pp. 796-799. doi:10.1016/j.amjoto.2018.09.001.
Roberts RA, Rivas A, Makowiec KF. Anterior Canal Benign Paroxysmal Positional Vertigo Following Surgical Management of Superior Canal Dehiscence. Am J Otolaryngol. 2018;39(6):796-799. PubMed PMID: 30224218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence. AU - Roberts,Richard A, AU - Rivas,Alejandro, AU - Makowiec,Kathryn F, Y1 - 2018/09/12/ PY - 2018/08/30/received PY - 2018/09/11/accepted PY - 2018/9/19/pubmed PY - 2019/2/16/medline PY - 2018/9/19/entrez KW - Anterior semicircular canal KW - Benign paroxysmal positional vertigo (BPPV) KW - Superior canal dehiscence KW - Vestibular SP - 796 EP - 799 JF - American journal of otolaryngology JO - Am J Otolaryngol VL - 39 IS - 6 N2 - OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD. METHOD: This case report presents an adult with residual dizziness following surgical management of SSCD and vestibular rehabilitation therapy (VRT). During subsequent evaluation of vestibular function, a transient and torsional, down-beating nystagmus was provoked along with vertigo during Dix-Hallpike positioning to the right. This was consistent with BPPV affecting the left superior (anterior) semicircular canal. RESULTS: The patient was treated with a repositioning maneuver to manage anterior semicircular canal BPPV and no nystagmus response was recorded with post-repositioning Dix-Hallpike test. Review of radiographic images, obtained prior to vestibular function testing, showed a hyperintensity in the area of the left anterior semicircular canal ampulla. It was felt this was likely a bone chip from the SSCD repair that was pushing against the ampulla with further mobile debris within the canal. CONCLUSION: It is reported that BPPV is a common complication in patients surgically managed for SSCD. Posterior semicircular canal BPPV is reported most often, with a couple of cases of lateral semicircular canal BPPV also reported. As far as we are aware, the current case represents the first report of anterior semicircular canal BPPV in this type of patient. SN - 1532-818X UR - https://www.unboundmedicine.com/medline/citation/30224218/Anterior_Canal_benign_paroxysmal_positional_Vertigo_following_surgical_Management_of_superior_canal_dehiscence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0709(18)30813-5 DB - PRIME DP - Unbound Medicine ER -