Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988-2006).
Bibliographic record
Abstract
OBJECTIVE: To assess the long-term efficacy and safety of posterior semicircular canal (PSCC) occlusion for intractable and incapacitating benign paroxysmal positional vertigo (BPPV) and identify lessons that may be learned from our experience. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral centre. METHODS: Clinical records and results of audiometric and vestibular testing were reviewed on a series of patients who underwent occlusion of the PSCC for intractable BPPV between 1988 and 2006. OUTCOME MEASURES: Postoperative neurotologic examination, audiometry, and vestibular testing were assessed. RESULTS: Thirty-two PSCC occlusion procedures were performed (24 females, 8 males; mean age 46 years). The average follow-up was 63 months. All patients had complete resolution of their PSCC positional vertigo, which has been maintained long term. Thirteen patients (40%) have experienced other forms of dizziness postoperatively (contralateral BPPV in four, continued Meniere disease attacks in three, ipsilateral lateral or superior canal BPPV in two, otolithic symptoms in two, continued oscillopsia in one, and subsequent cerebellar degeneration in one). Postoperative audiometry demonstrated an average reduction in pure-tone threshold of 6.1, 6.3, and 6.9 dB at 0.5 to 3, 4, and 8 kHz, respectively. Five patients had a mild to moderate reduction in caloric activity in the operated ear postoperatively. Two patients with Meniere disease had a significant postoperative caloric reduction. No patient had postoperative facial weakness. CONCLUSIONS: PSCC occlusion is a safe and highly effective treatment for intractable BPPV. However, other forms of vertigo may persist or arise subsequently in approximately 40% of cases. Patients with Meniere disease may be susceptible to increased caloric reduction postoperatively.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".