Efficacy and Safety of Bilateral Posterior Canal Occlusion in Patients With Refractory Benign Paroxysmal Positional Vertigo
Bibliographic record
Abstract
OBJECTIVE: To highlight the effectiveness, safety, and adverse effects of treating intractable posterior canal benign paroxysmal positional vertigo (BPPV) with bilateral posterior canal occlusions. PATIENTS: Included in this study are 6 patients diagnosed with bilateral BPPV refractory to medical treatment and particle repositioning maneuvers (PRMs) who underwent bilateral posterior semicircular canal occlusions. Patients were selected from tertiary hospital referral centers in London, Ontario, Canada, and St. Louis, Missouri, USA. INTERVENTIONS: This study used the following interventions: preoperative and postoperative audiogram testing to monitor long-term changes in hearing, computed tomography of the head to rule out central lesions and confirm normal inner ear anatomy before surgery, magnetic resonance imaging of the head as needed to rule out posterior fossa lesions causing persistent vertigo, Dix-Hallpike maneuver to diagnose BPPV, PRM and physiotherapy vestibular rehabilitation to attempt treating BPPV before surgical intervention, and sequential transmastoid posterior semicircular canal occlusion for treatment of intractable BPPV. MAIN OUTCOME MEASURES: Postoperative resolution of vertigo induced by head movement and hearing preservation by audiometric testing and postural stability. RESULTS: All patients with severe debilitating bilateral BPPV refractory to medical treatment and PRM had complete resolution of their positional vertigo after bilateral sequential posterior semicircular canal occlusion. Hearing was preserved at the preoperative level in all but 1 patient who developed bilateral postoperative, mild, high-tone sensorineural loss. Residual postoperative adverse effects included transient imbalance in all patients and episodic, nonpositional vertigo in 1 patient. When stressed by extreme head motion, some patients had mild residual instability. There were no other significant long-term complications. CONCLUSION: Bilateral sequential posterior semicircular canal occlusion is a definitive, effective, and safe treatment modality for intractable bilateral BPPV, providing patients with resolution of their vertiginous symptoms. All 6 patients stated that the alleviation of their BPPV symptoms far out-weighed the residual motion sensitivity resulting from the occluded canals.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".