Transection of the Posterior Ampullary Nerve for the Relief of Benign Paroxysmal Positional Vertigo

Abstract

Five patients with incapacitating benign paroxysmal positional vertigo (BPPV) for one year or longer were managed surgically by transection of the posterior ampullary nerve. An approach to this nerve was devised based upon a careful study of the posterior ampullary nerve in temporal bone dissections and specimens of the inner ear. Using the round window membrane as the principal landmark, the singular canal was exposed in the round window niche via a tympanotomy approach under local anesthesia. Transection of the posterior ampullary nerve promptly and completely relieved the signs and symptoms of BPPV in all five patients. A severe sensorineural hearing loss was produced in one case as a result of traumatic labyrinthitis. Transection of the posterior ampullary nerve in the round window niche is recommended to: 1) relieve severe BPPV of one or more years duration, and 2) add to the completeness of transcanal labyrinthectomy by denervating the inaccessible posterior canal crista.