[Semicircular canal occlusion].

Semicircular canal occlusion（SCO） is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional vertigo（BPPV）, Ménière's disease（MD）, labyrinthine fistula, and superior semicircular canal dehiscence syndrome, among others. This review aims to comprehensively summarize the development, evolution, relevant basic research, and clinical applications of semicircular canal occlusion, especially the application of endoscopic technology in recent years, and explore its practical value in the field of surgical treatment for vertigo.

Occlusion of the Lateral Semicircular Canal, Endolymphatic Sac Surgery, and Cochlear Implantation: A Low Destructive Treatment for Unilateral Ménière's Disease and Deafness.

INTRODUCTION: Surgical treatment of Ménière's disease (MD) and deafness aims to treat vertigo and hearing disabilities. Current treatment options like labyrinthectomy and cochlear implantation (CI) have shown acceptable results but are destructive. Less destructive procedures, like the occlusion of the lateral semicircular canal and endolymphatic sac surgery, have been shown to be successful in vertigo control. The combination of both procedures with CI has not been investigated; therefore the objective of this study was to investigate the outcome of this combination in patients with single-sided MD and moderately severe to complete sensorineural hearing loss. METHODS: In this retrospective study, 10 patients with single-sided MD and moderately severe to complete sensorineural hearing loss were included. In all of them, a single-staged surgery, which consisted of CI, endolymphatic sac surgery, and occlusion of the lateral semicircular canal, was performed. The surgery was performed after a failed conservative therapy trial. The clinical outcome was evaluated by the Dizziness Handicap Inventory (DHI) and audiological tests. These were assessed preoperatively, 3 and 6 months after surgery. An MRI with a hydrops sequence was performed to support the clinical diagnosis. RESULTS: After the combined surgery, the mean DHI testing improved significantly from 71 to 30. Mean audiological monosyllabic speech testing outcome with the cochlea implant was 65% at 65 dB. The residual hearing of 2 patients could be preserved after the surgical procedure. CONCLUSION: The combination of occlusion of the lateral semicircular canal, endolymphatic sac surgery, and CI is an efficient low traumatic treatment for patients with a single-sided MD and moderately severe to complete sensorineural hearing loss.

Treatment of Meniere's disease with simultaneous triple semicircular canal occlusion and cochlear implantation.

OBJECTIVE: Report three cases of simultaneous triple semicircular canal occlusion (TSCO) and cochlear implantation (CI) as the treatment of intractable Meniere's disease (MD). CASE REPORTS: Patients with MD can present occasionally with intractable vertigo and profound sensorineural hearing loss (SNHL). TSCO and CI have been proposed to control vertigo and restore profound deafness in patients with MD separately. However, a few studies have reported simultaneous TSCO and CI in the same surgical procedure for the treatment of MD. In the present study, we described three patients with MD showing incapacitating vertigo and severe SNHL who underwent simultaneous TSCO and CI after examinations of auditory system, vestibular system, and imaging. Their symptoms were significantly alleviated during the follow-up period. CONCLUSION: The combined TSCO and CI remains a viable treatment option which is effective for the control of vertigo as well as the restoring of hearing in patients with MD.

Analysis of postoperative effects of different semicircular canal surgical technique in patients with labyrinthine fistulas.

Objective: Different semicircular canal surgery techniques have been used to treat patients with labyrinthine fistulas caused by middle ear cholesteatoma. This study evaluated postoperative hearing and vestibular function after various semicircular canal surgeries. Materials and methods: In group 1, from January 2008 to December 2014, 29 patients with middle ear cholesteatoma complicated by labyrinthine fistulas were treated with surgery involving covering the fistulas with simple fascia. In group 2, from January 2015 to October 2021, 36 patients with middle ear cholesteatoma complicated by labyrinthine fistulas were included. Cholesteatomas on the surface of type I labyrinthine fistulas were cleaned using the "under water technique" and capped with a "sandwich" composed of fascia, bone meal, and fascia. Cholesteatomas on the surface of type II and III fistulas were cleaned using the "under water technique," and the labyrinthine fistula was plugged with a "pie" composed of fascia, bone meal, and fascia, and then covered with bone wax. Results: Some patients with labyrinthine fistulas in group 1 exhibited symptoms of vertigo after surgery. In group 2 Patients with type II labyrinthine fistulas experienced short-term vertigo after semicircular canal occlusion, but no cases of vertigo were reported during long-term follow-up. "sandwich." In patients with type II labyrinthine fistulas, the semicircular canal occlusion influenced postoperative hearing improvement. However, postoperative patient hearing was still superior to preoperative hearing. Conclusion: The surface of type I labyrinthine fistulas should be capped by a "sandwich" composed of fascia, bone meal, and fascia. Type II and III labyrinthine fistulas should be plugged with a "pie" composed of fascia, bone meal, and fascia, covered with bone wax.

Occlusion of two semicircular canals does not disrupt normal hearing in adult mice.

Vertigo is a debilitating disease affecting 15-20% of adults worldwide. Vestibular peripheral vertigo is the most common cause of vertigo, often due to Meniere's disease and benign paroxysmal positional vertigo. Although some vertigo symptoms can be controlled by conservative treatment and/or vestibular rehabilitation therapy, these treatments do not work for some patients. Semicircular canal occlusion surgery has proven to be very effective for these patients with intractable vertigo. However, its application is limited due to concern that the procedure will disrupt normal hearing. In this study, we investigated if occlusion of two semicircular canals would jeopardize auditory function by comparing auditory function and hair cell morphology between the surgical and contralateral ears before and after the surgery in a mouse model. By measuring the auditory brainstem response and distortion product otoacoustic emission 4 weeks post-surgery, we show that auditory function does not significantly change between the surgical and contralateral ears. In addition, confocal imaging has shown no hair cell loss in the cochlear and vestibular sensory epithelia, and scanning electron microscopy also indicates normal stereocilia morphology in the surgical ear. More importantly, the endocochlear potential measured from the surgical ear is not significantly different than that seen in the contralateral ear. Our study suggests that occlusion of two semicircular canals does not disrupt normal hearing in the mouse model, providing a basis to extend the procedure to patients, even those with normal hearing, benefitting more patients with intractable vertigo attacks.

Development of semicircular canal occlusion.

Surgical treatment of vertigo is performed with in-depth study of inner ear diseases. Achieving an effective control of vertigo symptoms while reducing damage to hearing and reducing surgical complications is the principle followed by scholars studying surgical modalities. Semicircular canal occlusion is aimed at treatment of partial peripheral vertigo disease and has attracted the attention of scholars because of the above advantages. This article provides a review of the origins of semicircular canal occlusion, related basic research, clinical applications, and the effects of surgery on vestibular and hearing function.

Changes of Vestibular Symptoms in Menière's Disease After Triple Semicircular Canal Occlusion: A Long-Term Follow-Up Study.

BACKGROUND: The clinical efficacy of triple semicircular canal occlusion (TSCO) and vestibular nerve resection (VNS) for patients with Ménière's disease has been unclear. OBJECTIVE: To explore changes in vestibular symptoms after TSCO and its advantages compared to the classical operation of VNS in patients with Menière's disease. METHODS: In total, 36 patients with Menière's disease performed TSCO or VNS at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China from May 2005 to July 2021, and all of them were enrolled in our study. Twelve of them underwent TSCO, 23 underwent VNS, and 1 had both treatments. We compared the demographic parameters, clinical symptoms, and selected test results between the two surgical methods. Ten patients each who underwent TSCO and VNS completed the follow-up. We collected and compared data pertaining to changes in vestibular symptoms. RESULTS: No significant difference in demographic parameters, clinical symptoms, or auditory or vestibular test results was detected between the two groups preoperatively. The TSCO group with vertigo as the main complaint experienced less residual paroxysmal dizziness after surgery than the VNS group (P = 0.020). Also, 57% of the patients in the VNS group had unsteadiness after surgery, while no such problems were reported in the TSCO group (P = 0.025). CONCLUSIONS: Our study shows that TSCO controls vertigo in most Menière's disease patients, and also has the advantage of lower rates of postoperative paroxysmal dizziness and unsteadiness than VNS. Thus, TSCO may be an effective surgery for refractory Menière's disease.

Case Report: Preservation of Otolithic Function After Triple Semicircular Canal Occlusion in a Patient With Intractable Ménière Disease.

Operative measures are considered when medical treatment fails to control vertigo in patients with intractable Ménière disease. The present report discusses a case in which triple semicircular canal occlusion was performed in a 30-year-old female patient who responded poorly to previously performed endolymphatic sac surgery. Her vestibular and auditory functions were evaluated both before and after surgery. Class A control of vertigo was achieved during the 76-month postoperative follow-up period. Ocular and cervical vestibular evoked myogenic potentials could be elicited before and after surgery. This case suggests that relatively long-term preservation of otolithic function can be achieved following triple semicircular canal occlusion, highlighting its potential as an alternative treatment for patients with Ménière disease.

[Efficacy of semicircular canal occlusion in the treatment of fifteen pateints with Meniere's disease].

Objective:To investigate the long-term efficacy of semicircular canal occlusion in the treatment of refractory Meniere's disease. Method:Fifteen patients with Meniere's disease who underwent semicircular canal occlusion were reviewed. The preoperative and postoperative frequency of vertigo ,quality of life, hearing and tinnitus level were compared. All patients were followed for more than 24 months. Result:Postoperatively, vertigo was controlled effectively in all 15 cases, and the control rate was 100%, of which 11 cases were completely controlled（Grade A） and 4 cases were basically controlled（Grade B）. The improvement rate of quality of life was 100%. The hearing worse in 4 cases（26.7%） and stabilized in 11 cases（73.3%）. The tinnitus was relieved in 7 cases（46.7%）, unchanged in 7 cases（46.7%） and aggravated in 1 case（6.7%）. Conclusion:Semicircular canal occlusion can effectively control the vertigo symptoms of refractory Meniere's disease and improve the quality of life. The long-term efficacy of semicircular canal occlusion is definite, but there is a risk of hearing loss.

Clinical long-term effects of surgical treatment for intractable Meniere's disease: a more than 13-year follow-up after pressure treatment and further surgical treatment for intractable vertigo.

Background: Meniere's disease appears to be a complex inner ear disorder and also remains a controversial and often difficult disease as regards determination of diagnosis, pathogenesis and especially optimal treatment.Aims/objectives: To investigate the long-term effects of progressive surgical treatment in the management of the vertigo attacks of intractable Meniere's disease.Material and methods: Eighteen patients with medically intractable and active Meniere's disease were opted to try Meniett pulse generator (Meniett), endolymphatic sac decompression (ESD) and triple semicircular canal occlusion (TSCO) in order to control the attacks of vertigo. Patients were indicated on the symptom report card the maximum level of vertigo, activity and stress.Results: Of 18 patients with medically intractable and active Meniere's disease during mean 165-month follow-up, the attacks of vertigo were effectively controlled in 14 patients by Meniett (77.78%), 2 patients by Meniett and ESD (11.11%), 2 patients by Meniett, ESD and TSCO (11.11%).Conclusions and significance: It is of great importance for intractable Meniere's disease to select surgically combined treatment process including Meniett, ESD and TSCO to effectively control the attacks of vertigo and a long-term follow-up.

Benign paroxysmal positional vertigo.

OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed. METHODS: A comprehensive review of the literature regarding BPPV up through June 2018 was performed. RESULTS: BPPV is typified by sudden, brief episodes of vertigo precipitated by specific head movements. While often self-limited, BPPV can have a considerable impact on quality of life. The diagnosis can be established with a Dix-Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal, and typically does not require additional ancillary testing. Understanding the pathophysiology of both canalithiasis and cupulolithiasis has allowed for the development of various repositioning techniques. Of these, the particle repositioning maneuver is an effective way to treat posterior canal BPPV, the most common variant. Options for operative intervention are available for intractable cases or patients with severe and frequent recurrences. CONCLUSIONS: A diagnosis of BPPV can be made through clinical history along with diagnostic maneuvers. BPPV is generally amenable to in-office repositioning techniques. For a small subset of patients with intractable BPPV, canal occlusion can be considered. LEVEL OF EVIDENCE: N/A.

[Efficacy of semicircular canal occlusion in the treatment of stage 3 or 4 Ménière's disease].

Objective:To investigate the efficacy of semicircular canal occlusion in the treatment of intractable Ménière's disease in stage 3 or 4.Method:Retrospective analysis of clincal date of twenty-nine patients who were referred to our institute and diagonsed with Ménière's disease. According to the preoperative staging of hearing, there were 12 cases in stage 3 and 17 cases in stage 4, and all patients underwent semicircular canal occlusion. The preoperative and postoperative frequency of vertigo, hearing, caloric test, functional level and tinnitus level were compared. Postoperative following-up period was 6-23 months, with an average of 13 months.Result:Postoperatively, vertigo was controlled effectively in all 29 cases, of which 26 cases(89.7%) were completely controlled and 3 cases(10.3%) were basic controlled. The hearing stabilized in 25 cases(86.2%), worse in 2 cases(6.9%) and improved in 2 cases(6.9%). The semicircular canal function of all patients were in low status by caloric test. The rate of tinnitus relief and functional improvement was 41.4%(12/29) and 96.6%(28/29).Conclusion:Semicircular canal occlusion is an effective measure for treatment of Ménière's disease in stage 3 or stage 4, especially in controlling vertigo and improving functional level, but the long-term follow-up is necessary.

[Triple semicircular canal occlusion with cochlear implantation for delayed endolymphatic hydrops: a case report].

A 46-year-old female with profound sensorineural hearing loss in her left ear from childhood developed tinnitus and fluctuating hearing loss on the right side 8 years ago. Four years later, paroxysmal episodes of rotatory vertigo occurred with gradually increased frequency, lasting from half an hour to 2 hours and accompanied with nausea and vomiting. Audiometric test revealed severe sensorineural hearing loss in both of her ears. The tympanograms showed type A on both sides. The threshold of auditory brainstem response was 97 dBnHL in her right ear while no waves could be educed on her left side. Weakened right-sided vestibular function was confirmed on caloric testing and vestibular-evoked myogenic potential. A normal cochlear morphology and clearness cerebellopontine angle were shown in the MR imaging scan. She was diagnosed with Delayed Endolymphatic Hydrops.

A Case of Free-Floating Endolymph Particle Found during Transmastoid Posterior Semicircular Canal Occlusion for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Benign paroxysmal positional vertigo (BPPV) is a common inner ear cause of vertigo, most of which can be treated by particle repositioning maneuver (PRM). However, in rare cases, positional vertigo could persist or frequently recur after several PRM. In these intractable cases, surgical treatments including singular neurectomy and semicircular canal occlusion have been used. Posterior semicircular canal occlusion has some advantages over singular neurectomy in hearing preservation and feasible surgical technique. Also free-floating endolymph particles causing intractable BPPV are known to occur in about 20% of the cases during canal occlusion surgery. Nevertheless, to the best of our knowledge, there has not been any report on the identification of those particles in the Korean literature. In this paper, we report a case of free-floating endolymph particle found during transmastoid posterior semicircular canal occlusion for intractable posterior canal BPPV.

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

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, nausea, and vomiting, which resolved within 2 weeks. In addition, 1 patient (33.3%) had transient tinnitus, which resolved after 4 months. There were no other significant long-term complications. CONCLUSION: Semicircular canal occlusion appears to be a safe and well-tolerated treatment modality for intractable HSC-BPPV. However, further studies with large sample sizes are needed to confirm our conclusion.

Perioperative nursing of 18 patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion / 现代临床护理

Objective To explore the perioperative nursing of patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion. Method A retrospective analysis was performed to the experience of nursing 18 patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion.Results The treatments for 17 cases were effective.Two of them had postoperative vertigo and then cured after further treatments.During one year follow-up,17 of them reported no occurrence of vertigo except only one care reporting paroxysmal positional vertigo. Conclusion Preoperative mental care and postoperative observation of the disease are critical for the enhanced curative effects.