Singular neurectomy in the management of paroxysmal positional vertigo

Paroxysmal positional vertigo is one of the common causes of episodic vertigo seen in neurotologic practice. It is thought to be caused by high specific gravity deposits in the cupula (cupulolithiasis) or membranous posterior semicircular canal (canalithesis) as a result of trauma, aging, viral insult, or surgical insult to the inner ear. The vast majority (90%) of patients undergo spontaneous resolution or cure by positioning maneuvers designed to dislodge the otoconial debris. The very small number of patients with disabling chronic paroxysmal positional vertigo (more than 1 year duration) can be effectively relieved of the positional vertigo (95%) by selective transection of the nerve supply to the posterior canal sense organ (singular neurectomy) through a tympanotomy approach using local anesthesia. The risk of sensorineural hearing loss is 3%.