The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.

The Vestibular System and Ageing.

Background:Some studies have suggested that semicircular canal occlusion is effective and safe for treating intractable posterior semicircular benign paroxysmal positional vertigo (PSC-BPPV), and adverse effects of canal occlusions for intractable horizontal semicircular BPPV (HSC-BPPV) were rarely reported. The aim of this study was to retrospectively discuss the efficacy of semicircular canal occlusion for intractable HSC-BPPV with at least 2 years of follow-up.Methods:From 2000 to 2011, 3 female patients (average age = 60 ± 6.9 years), with a diagnosis of HSC-BPPV refractory to head-shake and barbecue roll maneuver, underwent semicircular canal occlusion treatment in our hospital. The supine roll test was performed to diagnose HSC-BPPV and evaluate the treatment efficacy.Results:All patients with intractable HSC-BPPV had complete resolution of their positional vertigo after semicircular canal occlusion with a negative supine roll test. All patients reported transient postoperative disequilibrium, nause...

Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo.

The aim of this study was to evaluate the effects of argon laser irradiation of the semicircular canals using computed tomography (CT) images and to examine the basis for laser treatment for benign paroxysmal positional vertigo (BPPV). CT images of the posterior canal were evaluated postoperatively in a patient with intractable BPPV, in whom the unilateral posterior and lateral semicircular canals were irradiated with an argon laser. In addition, bootstrap analysis of 20 patients with normal CT findings of the temporal bone was performed and previous experimentally obtained histologic findings were compared. Cross-sections of the posterior canals of 20 patients were found to show no difference in size between the right and left sides. The laser-irradiated posterior canal became narrower than that on the non-irradiated healthy side in our patient. There was a discrepancy between the CT images and experimentally obtained histologic findings that showed complete occlusion of the canal. CT images of a...

Laser irradiation of the semicircular canal: occlusion of the canal or duct.

Keywords: BPPV, Benign Paroxysmal Positional Vertigo; Dix-Hallpike procedure; Epley maneuver DOI: 10.3126/njenthns.v1i2.4764 Nepalese J ENT Head Neck Surg Vol.1 No.2 (2010) p.28-32

/pdf/benign-paroxysmal-positional-vertigo-present-perspective-4i2iy2tnrk.pdf

Benign Paroxysmal Positional Vertigo: Present Perspective

Surgical Treatments of Benign Paroxysmal Positional Vertigo

Objective: To observe the long-term effect of laser occlusion of the posterior semicircular canal for benign paroxysmal positional vertigo. Method: Case report and review of the relevant world literature. Results: We treated a patient with refractory benign paroxysmal positional vertigo using laser occlusion of the posterior semicircular canal, and achieved satisfactory results. Three months after the operation, the patient was able to lead a normal life. There was no recurrence over five years of follow up. Conclusion: To our knowledge, this is the first report in the world literature of a patient with refractory benign paroxysmal positional vertigo being treated with laser occlusion of the posterior semicircular canal. This method had long-term effectiveness, and may be one of the most effective methods of treating patients with refractory benign paroxysmal positional vertigo.

Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report.

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Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report.